Cardiac protection takes off

Protecting the heart from ischaemia- and reperfusion-induced injury represents the greatest challenge of cardiology, since myocardial infarction is the major cause of mortality in industrialized countries. Research on cardiac protection has a long history in the discovery of new principles of protection, replete with triumphs but also broken dreams with respect to their clinical application. Treatment of acute myocardial infarction nowadays commences with a rapid opening of the occluded coronary vessel by percutaneous coronary intervention (PCI). When recanalization is achieved, ischaemia is followed by reperfusion. Even though reperfusion restores blood flow, oxygen, and nutrient supply to the cardiac muscle, it does not simply put an end to the cellular disturbance and injury elicited by the period of ischaemic malsupply of the affected myocardium; reperfusion may also aggravate damage to the myocardium beyond that occurring during the preceding period of ischaemia. Therefore, cardiac malfunction and manifest tissue damage after ischaemia–reperfusion may be due to events during ischaemia as well as additional ones during reperfusion, and different routes of protection need to be considered for the (pre)ischaemic or post-ischaemic period. The known mechanisms of protection include targets … *Corresponding author. Tel: +49 641 9947 241; fax: +49 641 9947 239; E-mail address : cvr{at}physiologie.med.uni-giessen.de