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

Campo, Gianluca, Pavasini, Rita, Morciano, Giampaolo, Lincoff, A. Michael, Gibson, C. Michael, Kitakaze, Masafumi, Lonborg, Jacob, Ahluwalia, Amrita, Ishii, Hideki, Frenneaux, Michael, Ovize, Michel, Galvani, Marcello, Atar, Dan, Ibanez, Borja, Cerisano, Giampaolo, Biscaglia, Simone, Neil, Brandon J., Asakura, Masanori, Engstrom, Thomas, Jones, Daniel A., Dawson, Dana, Ferrari, Roberto, Pinton, Paolo and Ottani, Filippo (2017) 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. International Journal of Cardiology, 244. pp. 59-66. ISSN 1874-1754

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Abstract

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.

Item Type: Article
Uncontrolled Keywords: mitochondrial function,st-segment elevation myocardial infarction,primary percutaneous coronary intervention,mortality,reperfusion injury
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: Pure Connector
Date Deposited: 13 Jun 2017 05:06
Last Modified: 11 Jun 2020 00:26
URI: https://ueaeprints.uea.ac.uk/id/eprint/63737
DOI: 10.1016/j.ijcard.2017.06.040

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