Cardioprotection in perspective
Despite the increasing use, better logistics and improved methodology of interventional approaches for coronary reperfusion, the mortality and morbidity from acute myocardial infarction are still substantial. This is very clear when examining the real world data. This issue is complex: patients with acute myocardial infarction are typically advanced in age, have comorbidities and are receiving several medications. For them, it is necessary to consider not only infarct size reduction but also attenuation of coronary microvascular obstruction, as well as longer-term targets including infarct repair and reverse remodelling.
In this review, G. Heusch (Germany) states that the signalling pathways triggered by ischaemic conditioning are complex. Ischaemic postconditioning and remote ischaemic conditioning reduced infarct size in patients with ST-segment elevation myocardial infarction in proof-of-concept trials.
In future studies, the use of additive cardioprotective strategies in patients with severe haemodynamic alterations is suggested.
Take-home message: Sustained myocardial ischaemia–reperfusion induces various modes of cardiomyocyte death and coronary microvascular injury. Ischaemic conditioning reduces infarct size and coronary microvascular injury. Moreover, remote ischaemic conditioning improved clinical outcomes in patients with ST-segment elevation myocardial infarction in one phase III clinical trial.