Cardiac Preconditioning during Percutaneous Coronary Interventions

Abstract

Ischemic preconditioning (PC) is a polygenic defensive cellular adaptive phenomenon of the heart to ischemic stress, whereby the heart changes its phenotype to become more resistant to subsequent ischemia. Early and late of PC represent two chronologically and pathophysiologically distinct phases of this phenomenon, which can be recruited pharmacologically. We represent a post hoc analysis examining the late PC-mimetic effects of nitroglycerin (NTG) on peri-procedural myocardial necrosis during percutaneous coronary intervention (PCI). A group of 66 patients presenting with angina were randomized, 24 h prior to a scheduled PCI for single obstructive CAD, to a 4 h pretreatment with intravenous NTG or saline. Measurements of electrocardiographic ST-segment shifts, echocardiographic regional wall motion and angina scores demonstrated that NTG pre-treatment preconditioned the heart by rendering it resistant to ischemia during balloon inflations. NTG-pretreated patients exhibited trends towards lower average peak CK (131.1 vs. 188.6 U/L, P = 0.38) and CK-MB levels (7.1 vs. 12.6 ng/ml, P = 0.40). NTG, however, had no significant impact on the incidence of post-procedural MI or any cardiac enzyme elevation. The exploitation of ischemic and pharmacological PC may prove a useful strategy to confer cardioprotection during high-risk PCI and is worth exploring.

Use of donors who have suffered cardiopulmonary arrest and resuscitation in lung transplantation☆

“…It consists of a short period of ischemia followed by reperfusion, which protects from subsequent severe ischemia/reperfusion. Recent reports confirm the efficacy of preconditioning in cardiac surgery and percutaneous coronary interventions in humans [19,20]. IP uses endogenous as well as distant mechanisms in skeletal muscle, liver, kidney, intestine and brain in animal models.…”

Pathophysiology of myocardial reperfusion injury: preconditioning, postconditioning, and translational aspects of protective measures

“…However, because scheduled cardiac surgeries usually employ cardioplegia and anesthesia, which have the potential to provide cardioprotection (42), the added benefit of additional treatments seems controversial even after prospective clinical trials (216). Even in the case of elective percutaneous coronary intervention, the preceding use of some drugs such as statins was reported to reduce myocardial injury (132), but the application of its putative downstream mediator by nitroglycerin before ischemic insult failed to exert any significant cardioprotection (82). One of the reasons it may be difficult to identify preischemic pharmacological strategies mimicking "triggers of preconditioning" could be the critical timing and intensity required for procedures in clinical situations.…”

Cardioprotection and mitochondrial S-nitrosation: Effects of S-nitroso-2-mercaptopropionyl glycine (SNO-MPG) in cardiac ischemia–reperfusion injury

“…Potential sources of cardioprotective NO • include endogenous production by NO • synthases (NOSs) [15,18], or exogenous administration of various NO • precursors including S-nitrosoglutathione (GSNO) [19], nitroglycerine [20], or nitrite [21]. Notably, NO • can control a number of mitochondrial functions such as Ca 2+ accumulation and PT pore opening [1,22].…”