Endogenous cardioprotective strategies

The field of cardioprotection to reduce reperfusion injury has been characterized by a plethora of experimental studies with multiple pharmacological agents that have shown great promise in the laboratory, but have lacked clinical efficacy. This has led to diminishing enthusiasm for the translation of cardioprotection into clinical practice. In contrast, the field of endogenous cardiac protection is particularly appealing given that early clinical studies have documented feasibility and efficacy. Strategies for endogenous cardioprotection include ischemic preconditioning, ischemic postconditioning, and remote ischemic conditioning. However, the clinical trials performed to date have been small, used surrogate endpoints, and had strict inclusion and exclusion criteria. Larger trials are needed that will allow assessment of the applicability to a wider patient population with prior infarcts, prior revascularization, reduced ejection fraction, history of congestive heart failure, use of multiple pharmacological agents, and presence of multiple coexisting diseases. Moreover, understanding the mechanisms for the apparent benefit may lead to the development of new drugs and molecules that could target the fundamental processes of ischemia-reperfusion injury.