title: Remote Ischemic Conditioning for Patients With STEMI.
abstract: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of death and morbidity, despite declining incidence and improved short-term outcome in many countries. Although mortality declines in developed countries with easy and fast access to optimized treatment, development of heart failure often remains a challenge in survivors and still approaches 10% at 1 year. Rapid admission and acute interventional treatment combined with modern antithrombotic pharmacologic therapy frequently establish complete reperfusion and acutely stabilize the patient, but the reperfusion itself adds further to the damage in the myocardium compromising the long-term outcome. Reperfusion injury is believed to be a significant-if not the dominant-contributor to the net injury resulting from STEMI and has become a major focus of research in recent years. Despite a plethora of pharmacological and mechanical interventions showing consistent reduction of reperfusion injury in experimental models, translation into a clinical setting has been challenging. In patients, attempts to modify reperfusion injury by pharmacological strategies have largely been unsuccessful, and focus is increasingly directed toward mechanical modalities. Remote ischemic conditioning of the heart is achieved by repeated brief interruption of the blood supply to a distant part of the body, most frequently the arm. At present, remote ischemic conditioning is the most promising adjuvant therapy to reduce reperfusion injury in patients with STEMI. In this review, we discuss the results of clinical trials investigating the effect of remote ischemic conditioning in patients admitted with STEMI and potential reasons for its apparent superiority to current pharmacologic adjuvant therapies.
authors.affiliation: 1 Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Michael Rahbek
authors.initials: MR
authors.lastname: Schmidt
authors.affiliation: 1 Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Mathis Ersted
authors.initials: ME
authors.lastname: Rasmussen
authors.affiliation: 1 Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
mesh_terms: D000818:Animals; D002317:Cardiovascular Agents / Q000627:therapeutic use; D006801:Humans; D019194:Ischemic Preconditioning / Q000009:adverse effects / Q000379:methods*; D015425:Myocardial Reperfusion / Q000009:adverse effects* / Q000379:methods; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D009206:Myocardium / Q000473:pathology; D065840:Protective Factors; D012039:Regional Blood Flow; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: myocardial infarction; remote ischemic conditioning; reperfusion injury