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Extract

By failing to prepare, you are preparing to fail.

(Benjamin Franklin)

Timely reperfusion of the acutely ischaemic myocardium in patients with ST-elevation myocardial infarction (STEMI) is associated with enhanced myocardial salvage and improved survival rates.1,2 Despite the overwhelming evidence in favour of prompt reperfusion with primary percutaneous coronary intervention, other factors, such as the size of the area at risk, collateral circulation, pre-infarction angina (PA) as well as pre and postconditioning, have been also shown to influence the results of infarct size reduction studies.3

The most powerful intervention in experimental studies which augments the benefits of rapid reperfusion following coronary occlusion is ischaemic preconditioning.4,5 The possibility that an innate mechanism of myocardial protection might be inducible in the human heart has generated considerable excitement and enthusiastic research. Data from limited clinical studies are encouraging by demonstrating that brief episodes of ischaemia before a total coronary occlusion in STEMI protect the heart and result in a smaller infarct size.6 It has been speculated that preconditioning may occur naturally in patients with myocardial infarction as angina preceding an acute myocardial infarction. Indeed, the presence of PA has a significant impact on the clinical course of myocardial infarction. PA has been shown to be associated with reduced infarct size, improved left-ventricular function, a decrease in the number of cardiac arrhythmias, and improved clinical outcome.7–9 However, data from clinical studies are scarce and hampered by small sample sizes, selected populations, single-centre and retrospective study designs.

Issue Section:
Editorial
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