Buske Maria, Desch Steffen, Heusch Gerd, Rassaf Tienush, Eitel Ingo, Thiele Holger, Feistritzer Hans-Josef
Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, 04289 Leipzig, Germany.
Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, 45122 Essen, Germany.
J Clin Med. 2023 Dec 27;13(1):159. doi: 10.3390/jcm13010159.
While early coronary reperfusion via primary percutaneous coronary intervention (pPCI) is established as the most efficacious therapy for minimizing infarct size (IS) in acute ST-elevation myocardial infarction (STEMI), the restoration of blood flow also introduces myocardial ischemia-reperfusion injury (IRI), leading to cardiomyocyte death. Among diverse methods, ischemic conditioning (IC), achieved through repetitive cycles of ischemia and reperfusion, has emerged as the most promising method to mitigate IRI. IC can be performed by applying the protective stimulus directly to the affected myocardium or indirectly to non-affected tissue, which is known as remote ischemic conditioning (RIC). In clinical practice, RIC is often applied by serial inflations and deflations of a blood pressure cuff on a limb. Despite encouraging preclinical studies, as well as clinical studies demonstrating reductions in enzymatic IS and myocardial injury on imaging, the observed impact on clinical outcome has been disappointing so far. Nevertheless, previous studies indicate a potential benefit of IC in high-risk STEMI patients. Additional research is needed to evaluate the impact of IC in such high-risk cohorts. The objective of this review is to summarize the pathophysiological background and preclinical and clinical data of IRI reduction by IC.
虽然通过直接经皮冠状动脉介入治疗（pPCI）进行早期冠状动脉再灌注已被确立为使急性ST段抬高型心肌梗死（STEMI）梗死面积（IS）最小化的最有效疗法，但血流恢复也会引发心肌缺血再灌注损伤（IRI），导致心肌细胞死亡。在多种方法中，通过重复缺血和再灌注循环实现的缺血预处理（IC）已成为减轻IRI最有前景的方法。IC可通过将保护性刺激直接应用于受影响的心肌或间接应用于未受影响的组织来进行，这被称为远程缺血预处理（RIC）。在临床实践中，RIC通常通过对肢体上的血压袖带进行连续充气和放气来应用。尽管临床前研究令人鼓舞，且临床研究表明酶促IS降低以及影像学上心肌损伤减轻，但迄今为止观察到的对临床结局的影响却令人失望。然而，先前的研究表明IC对高危STEMI患者有潜在益处。需要进一步研究来评估IC在这类高危人群中的影响。本综述的目的是总结IC减轻IRI的病理生理背景以及临床前和临床数据。
