Clinical benefit of drugs targeting mitochondrial function as an adjunct to reperfusion in ST-segment elevation myocardial infarction: A meta-analysis of randomized clinical trials

TY - JOUR

T1 - Clinical benefit of drugs targeting mitochondrial function as an adjunct to reperfusion in ST-segment elevation myocardial infarction

T2 - A meta-analysis of randomized clinical trials

AU - Campo, Gianluca

AU - Pavasini, Rita

AU - Morciano, Giampaolo

AU - Lincoff, A Michael

AU - Gibson, C Michael

AU - Kitakaze, Masafumi

AU - Lonborg, Jacob

AU - Ahluwalia, Amrita

AU - Ishii, Hideki

AU - Frenneaux, Michael

AU - Ovize, Michel

AU - Galvani, Marcello

AU - Atar, Dan

AU - Ibanez, Borja

AU - Cerisano, Giampaolo

AU - Biscaglia, Simone

AU - Neil, Brandon J

AU - Asakura, Masanori

AU - Engstrom, Thomas

AU - Jones, Daniel A

AU - Dawson, Dana

AU - Ferrari, Roberto

AU - Pinton, Paolo

AU - Ottani, Filippo

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - AIMS: To perform a systematic review and meta-analysis of randomized clinical trials (RCT) comparing the effectiveness of drugs targeting mitochondrial function vs. placebo in patients with ST-segment elevation myocardial infarction (STEMI) undergoing mechanical coronary reperfusion.METHODS: Inclusion criteria: RCTs enrolling STEMI patients treated with primary percutaneous coronary intervention (PCI) and comparing drugs targeting mitochondrial function vs. placebo. Odds ratios (OR) were computed from individual studies and pooled with random-effect meta-analysis.RESULTS: Fifteen studies were identified involving 5680 patients. When compared with placebo, drugs targeting mitochondrial component/pathway were not associated with significant reduction of cardiovascular and all-cause mortality (OR 0.9, 95% CI 0.7-1.17 and OR 0.92, 95% CI 0.69-1.23, respectively). However, these agents significantly reduced hospital admission for heart failure (HF) (OR 0.64; 95% CI 0.45-0.92) and increased left ventricular ejection fraction (LVEF) (OR 1.44; 95% CI 1.15-1.82). After analysis for subgroups according to the mechanism of action, drugs with direct/selective action did not reduce any outcome. Conversely, those with indirect/unspecific action showed a significant effect on cardiovascular mortality (0.65, 95% CI 0.46-0.92), all-cause mortality (OR 0.69, 95% CI 0.52-0.92), hospital readmission for HF (OR 0.41, 95% CI 0.28-0.6) and LVEF (OR 1.49, 95% CI 1.09-2.05).CONCLUSIONS: Administration of drugs targeting mitochondrial function in STEMI patients undergoing primary PCI appear to have no effect on mortality, but may reduce hospital readmission for HF. The drugs with a broad-spectrum mechanism of action seem to be more effective in reducing adverse events.

AB - AIMS: To perform a systematic review and meta-analysis of randomized clinical trials (RCT) comparing the effectiveness of drugs targeting mitochondrial function vs. placebo in patients with ST-segment elevation myocardial infarction (STEMI) undergoing mechanical coronary reperfusion.METHODS: Inclusion criteria: RCTs enrolling STEMI patients treated with primary percutaneous coronary intervention (PCI) and comparing drugs targeting mitochondrial function vs. placebo. Odds ratios (OR) were computed from individual studies and pooled with random-effect meta-analysis.RESULTS: Fifteen studies were identified involving 5680 patients. When compared with placebo, drugs targeting mitochondrial component/pathway were not associated with significant reduction of cardiovascular and all-cause mortality (OR 0.9, 95% CI 0.7-1.17 and OR 0.92, 95% CI 0.69-1.23, respectively). However, these agents significantly reduced hospital admission for heart failure (HF) (OR 0.64; 95% CI 0.45-0.92) and increased left ventricular ejection fraction (LVEF) (OR 1.44; 95% CI 1.15-1.82). After analysis for subgroups according to the mechanism of action, drugs with direct/selective action did not reduce any outcome. Conversely, those with indirect/unspecific action showed a significant effect on cardiovascular mortality (0.65, 95% CI 0.46-0.92), all-cause mortality (OR 0.69, 95% CI 0.52-0.92), hospital readmission for HF (OR 0.41, 95% CI 0.28-0.6) and LVEF (OR 1.49, 95% CI 1.09-2.05).CONCLUSIONS: Administration of drugs targeting mitochondrial function in STEMI patients undergoing primary PCI appear to have no effect on mortality, but may reduce hospital readmission for HF. The drugs with a broad-spectrum mechanism of action seem to be more effective in reducing adverse events.

KW - Cardiovascular Agents/administration & dosage

KW - Drug Delivery Systems/methods

KW - Humans

KW - Mitochondria/drug effects

KW - Myocardial Reperfusion/methods

KW - Randomized Controlled Trials as Topic/methods

KW - ST Elevation Myocardial Infarction/diagnosis

KW - Treatment Outcome

U2 - 10.1016/j.ijcard.2017.06.040

DO - 10.1016/j.ijcard.2017.06.040

M3 - Review

C2 - 28634037

SN - 0167-5273

VL - 244

SP - 59

EP - 66

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -