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09 June 2020 : Review article  

Postconditioning with Nitrates Protects Against Myocardial Reperfusion Injury: A New Use for an Old Pharmacological Agent

Zhu Meng1CDE, Weili Gai1DF, Dalin Song1ACD*

DOI: 10.12659/MSM.923129

Med Sci Monit 2020; 26:e923129

Abstract

Early reperfusion remains the key therapy to salvage viable myocardium and must be applied as soon as possible following an acute myocardial infarction (AMI) to attenuate the ischemic insult. However, reperfusion injury may develop following reintroduction of blood and oxygen to vulnerable myocytes, which results in more severe cell death than in the preceding ischemic episode. Ischemic postconditioning (I-PostC) provides a cardioprotective effect in combination with pharmacological agents. Although nitrates have been tested in many experimental and clinical studies of acute AMI to evaluate the cardioprotective effect, few investigations have been focused on nitrates postconditioning in patients undergoing percutaneous coronary intervention (PCI). This review presents the manifestations of myocardial reperfusion injury (RI) and potential mechanisms underlying it, and provides the mechanisms involved in the cardioprotection of I-PostC. We also present a new therapeutic approach to attenuate RI by use of an ‘old’ agent – nitrates – in AMI patients.

Keywords: acute coronary syndrome, Ischemic Postconditioning, Nitrates, Ischemia, Myocardial Reperfusion, Myocardial Reperfusion Injury, Myocardium, percutaneous coronary intervention

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750