title: Cardiac Remote Ischaemic Preconditioning: Mechanistic and Clinical Considerations.
abstract: Brief, non-harmful ischaemic insults to an organ remote from the heart, remote ischaemic preconditioning (RIPC), has been proposed to confer protection to the heart against ischaemia-reperfusion injury. While most clinical trials of RIPC during coronary interventions (PCI) suggest benefit, recent large, multicentre trials in coronary artery bypass surgery suggest a lack of efficacy. Mechanistically, RIPC most likely promotes the release of circulating factors which modulate multiple cellular pathways in the heart, promoting cell survival. This review explores potential mechanisms underlying RIPC and includes a contemporary evaluation of clinical studies in PCI and cardiac surgery, highlighting methodological differences which may explain discrepant findings between these two clinical groups.
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jerrett K
authors.initials: JK
authors.lastname: Lau
authors.affiliation: ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia.
authors.forename: Gabrielle J
authors.initials: GJ
authors.lastname: Pennings
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
authors.forename: Andy
authors.initials: A
authors.lastname: Yong
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia. Electronic address: leonard.kritharides@sydney.edu.au.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D015428:Myocardial Reperfusion Injury / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*
keywords: Coronary artery bypass grafting surgery; Ischaemia reperfusion injury; Percutaneous coronary intervention; Remote ischaemic preconditioning