[The endogenous cardioprotection during reperfusion in acute myocardial infarction]

A prompt primary percutaneous coronary intervention with aspiration thrombectomy and subsequent stent implantation at the culprit lesion combined with optimal anti-platelet and anti-thrombotic pharmacotherapy is the safest and most effective reperfusion strategy. Unfortunately, this therapy does not guarantee always a good, long-term clinical outcome and left ventricular function recovery. Despite the unquestionable benefit of reperfusion, we have evidence that its initial phase leads to additional damage at the area at risk, so the final effect is the compromise between benefits and destruction, which come with the reperfusion wavefront. Experimental studies suggest that postconditioning with several very brief cycles of ischaemia alternating with reperfusion applied immediately after relief of a prolonged epicardial occlusion is associated with the infarct size limitation. The cellular protective effect of postconditioning seems to be related to prevention of mitochondrial permeability transition pore activation. We have still to wait for confirmation of the clinical effectiveness of both postconditionig as well as pharmacotherapy that mimics postconditioning effects (e.g. with cyclosporine) in a randomised, multicenter clinical trial with properly designed endpoint. To date, most clinically tested agents that induced endogenous cardioprotection such as adenosine, erythropoietin, protein kinase C-δ inhibitor, atrial natriuretic peptide, atorvastatin and nicorandil were failed to reduce infarct size. Time will tell whether postconditioning and therapy that it mimics meet expectation and find place in the recommendations concerning management of acute myocardial infarction. Kardiol Pol 2011; 69, supl. III: 67-74.