Ef fi cacy and Safety of Pressure-controlled Intermittent Coronary Sinus Occlusion in STEMI: A Systematic Review and Meta-analysis

This systematic review will provide a comprehensive assessment of the evidence on PICSO in STEMI patients, and it will help to determine the role of this novel technique in the management of STEMI. The review searched for the relevant articles in the PubMed, Embase, Cochrane Library, and Web of Science databases regarding PC-ICSO. Four cohort studies were eligible to be included in the quantitative analysis. In the pooled analysis, the use of PICSO was associated with a signi fi cant reduction in infarct size (SMD = - 0.44, 95% CI = - 0.76,-0.13, p = 0.004). PICSO administration was associated with a reduced risk of developing microvascular resistance (RR = 0.75, 95% CI = 0.62,0.92, p = 0.0051). The post-procedural Index of Microvascular Occlusion (MVO) was lower in the PICSO treated compared to the control group and this result was homogenous and statistically signi fi cant (SMD = - 0.35, 95% CI = - 0.68-0.01, p = 0.03, I 2 = 0%). Compared to matched controls, the use of PICSO was associated with higher Left Ventricular Ejection Fraction (LVEF) at the longest follow-up (SMD = 0.328, 95% CI = 0.03, 0.06, p = 0.03, I 2 = 0%). This review suggested that PICSO can be used during PPCI in STEMI with improved outcomes of infarct size, LVEF, and microvascular perfusion.