Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2014;67:394-404 - Vol. 67 Num.05 DOI: 10.1016/j.rec.2014.01.010

Protection Against Myocardial Ischemia-reperfusion Injury in Clinical Practice

David Garcia-Dorado a,, Antonio Rodríguez-Sinovas a, Marisol Ruiz-Meana a, Javier Inserte a

a Hospital Universitario e Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

Keywords

Reperfusion injury. Myocardial infarction. Remote ischemic conditioning. Protein kinase G.

Abstract

Even when reperfusion therapy is applied as early as possible, survival and quality of life are compromised in a considerable number of patients with ST-segment elevation acute myocardial infarction. Some cell death following transient coronary occlusion occurs during reperfusion, due to poor handling of calcium in the sarcoplasmic reticulum-mitochondria system, calpain activation, oxidative stress, and mitochondrial failure, all promoted by rapid normalization of intracellular pH. Various clinical trials have shown that infarct size can be limited by nonpharmacological strategies—such as ischemic postconditioning and remote ischemic conditioning—or by drugs—such as cyclosporine, insulin, glucagon-like peptide-1 agonists, beta-blockers, or stimulation of cyclic guanosine monophosphate synthesis. However, some clinical studies have yielded negative results, largely due to a lack of consistent preclinical data or a poor design, especially delayed administration. Large-scale clinical trials are therefore necessary, particularly those with primary clinical variables and combined therapies that consider age, sex, and comorbidities, to convert protection against reperfusion injury into a standard treatment for patients with ST-segment elevation acute myocardial infarction.

1885-5857/© 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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