Improvements in the treatment of AMI, mainly through timely reperfusion, have reduced negative outcomes in patients presenting with STEMI.
The challenge is to further protect the heart to prevent myocardial cell death during the time of ischemia and subsequent reperfusion. Several methods of cardioprotection have been investigated to limit infarction size in clinical trials with controversial results. The session held at ESC-2014 has been excellent with four speakers focusing on different aspects of cardioprotection.
M. Ovize (Lyon, FR) discussed existing results on ischemic and pharmacological post conditioning, providing a clear perspective of the current situation. Prof. Ovize emphasized that “several phase II trials have confirmed the existence and importance of lethal reperfusion injury in the heart”.
Interestingly H.E. Botker (Aarhus, DK) presented data on another type of cardioprotective intervention, remote ischemic conditioning (RIC) and how, when applied during transportation for primary PCI for STEMI, it increases myocardial salvage.
Additionally, Botker claimed that “RIC may be of benefit in stroke patients, suggesting that the benefits of RIC may go beyond mechanisms directly associated with reduction of infarct size”.
G. Heusch (Essen, DE) discussed impressive original data translating RIC interventions to CABG patients showing protection in terms of reduced troponin release and reduced mortality and MACCE rate during follow-up.
Finally, D.P Dutka (Cambridge, GB) centered the discussion on the existing, yet unresolved uncertainties on the delivery of RIC and the need of a better understanding of the underlying pathophysiology to establish optimal strategies for myocardial protection.
In summary, a state of the art session that has highlighted the need of pre-clinical and clinical research to further investigate present and newer cardioprotective strategies to reduce damage to the heart and improve the prognosis of patients suffering episodes of ischemia.