Ischaemic preconditioning and outcomes after angioplasty: effects of drug therapy.
Ischaemic preconditioning is one of the mechanisms by which human myocardium and human life are protected from ischaemic insults. One of the clinical situations in which we can discuss preconditioning is repetitive coronary occlusions by balloon inflation during elective percutaneous transluminal coronary angioplasty (PTCA) for stable angina pectoris. The severity of myocardial ischaemia assessed by ST-segment elevation or chest pain is less during the second balloon inflation compared with the first, if the duration of the first coronary occlusion is sufficient to precondition the myocardium. Many drugs have been identified that produce a reduction or induction in indices of preconditioning during PTCA. Preconditioning-mimetic drugs include adenosine, bradykinin, nitroglycerin and nicorandil. It is of paramount importance that we investigate and develop preconditioning-mimetic drugs which may enable an increased tolerance to effort angina, limit infarction size in susceptible patients, and decrease the incidence of sudden cardiac death as a result of ventricular tachyarrhythmias.
Kato
Toru
T
Division of Cardiology, Third Department of Internal Medicine, Saitama Medical Centre, Saitama Medical School, Kawagoe, Japan. torumed3@saitama-med.ac.jp
Yoshimoto
Nobuo
N
D000241:Adenosine / Q000627:therapeutic use; D000787:Angina Pectoris / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary; D001920:Bradykinin / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D008954:Models, Biological; D009203:Myocardial Infarction / Q000517:prevention & control; D020108:Nicorandil / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D015221:Potassium Channels / Q000187:drug effects / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D018047:Receptors, Purinergic P1 / Q000187:drug effects / Q000502:physiology
D015221:Potassium Channels; D018047:Receptors, Purinergic P1; D020108:Nicorandil; D005996:Nitroglycerin; D000241:Adenosine; D001920:Bradykinin