Issue: 2004 > December > review

Ischaemic preconditioning: from molecular characterisation to clinical application - part II

N.P. Riksen, P. Smits, G.A. Rongen


Ischaemic preconditioning was originally described in
animal hearts as histological infarct-size limitation by a
previous brief episode of ischaemia. In humans, ischaemic preconditioning has been demonstrated in several <i>in vitro</i> and <i>in vivo</i> models, including coronary artery bypass grafting and percutaneous transluminal coronary angiograplasty,
using surrogate markers of ischaemia and reperfusion
injury. Increasing knowledge of the molecular signalling
pathways mediating protection by ischaemic preconditioning has provided rational targets for pharmacological intervention. Several widely used drugs are able to mimic ischaemic preconditioning (e.g. adenosine, adenosineuptake inhibitors, ACE inhibitors, angiotensin II antagonists, statins, opioids, volatile anaesthetics and ethanol), whereas others inhibit ischaemic preconditioning-induced protection (e.g. sulphonylureas and adenosine antagonists).
The present review focuses on these different classes of
drugs. Prudent use or avoidance of these drugs in patients who are at risk for myocardial infarction could theoretically limit ischaemia and reperfusion injury.