Myocardial ischemic conditioning: Clinical implications
- Derek J Hausenloy, MD, PhD, FRCP, FACC, FESC
Derek J Hausenloy, MD, PhD, FRCP, FACC, FESC
- University College London
- Duke-National University Singapore
- Derek M Yellon, PhD, DSc, Hon FRCP, FACC, FESC
Derek M Yellon, PhD, DSc, Hon FRCP, FACC, FESC
- Professor of Molecular & Cellular Cardiology
- University College London
The myocardium possesses innate physiologic adaptive processes that render it more resistant to ischemic injury. Two important mechanisms are ischemic pre- and postconditioning. Other protective mechanisms include the long-term development of coronary collateral vessels and myocardial hibernation and stunning. (See "Coronary collateral circulation" and "Pathophysiology of stunned or hibernating myocardium".)
The potential clinical use of myocardial ischemic conditioning to improve outcomes in patients with coronary artery disease will be discussed here. The definition and pathogenesis of ischemic conditioning are discussed separately.
Ischemic pre- and postconditioning are types of ischemic conditioning.
Ischemic preconditioning — Myocardial ischemic preconditioning refers to the protection conferred to ischemic myocardium by preceding brief periods of sublethal ischemia separated by periods of reperfusion. (See "Myocardial ischemic conditioning: Pathogenesis" and "Myocardial ischemic conditioning: Pathogenesis", section on 'Ischemic preconditioning'.)
Ischemic postconditioning — Ischemic postconditioning refers to the ability of a series of brief occlusions of either the coronary or peripheral arterial circulation after a severe ischemic insult to protect against ischemic reperfusion injury of the myocardium. (See "Myocardial ischemic conditioning: Pathogenesis", section on 'Remote ischemic conditioning'.)
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- Ischemic preconditioning
- Ischemic postconditioning
- Remote ischemic preconditioning
- OBSERVATIONS IN HUMANS
- Warm-up angina
- Unstable angina (preinfarction)
- Percutaneous coronary intervention
- Coronary artery bypass graft surgery
- THERAPEUTIC APPLICATIONS
- Coronary artery bypass graft surgery
- Acute coronary syndromes
- PCI in patients with stable coronary artery disease
- SUMMARY AND RECOMMENDATIONS