Clinical Application of Remote Ischemic Preconditioning

Ischemic preconditioning1 has been shown to reliably re-duce ischemic myocardial cell necrosis in a host of animal models.2 Although preconditioning is one of the most pow-erful and reproducible phenomena in cardioprotection, it has not readily translated to routine clinical use. One issue is that the timing of the long duration of ischemia must be known in advance and the treatment must be applied before the long duration of ischemia. Thus, although evidence suggests that preinfarction ischemia (angina) before an ST-segment eleva-tion myocardial infarction is associated with smaller infarct size and better clinical outcome,3 there is no reliable way to predict when a myocardial infarction will occur and hence no way to either induce ischemic preconditioning or apply a preconditioning mimetic agent just before the infarction. There are, of course, situations in which myocardial ischemia is planned, eg, during coronary artery balloon angioplasty,