Myocardial protection in man—from research concept to clinical practice Dennis V. Cokkinos Æ Costas Pantos Published online: 1 June 2007 Ó Springer Science+Business Media, LLC 2007 Abstract Myocardial protection aims at preventing myocardial tissue loss: (a) In the acute stage, i.e., during primary angioplasty in acute myocardial infarction. In this setup, the attenuation of reperfusion injury is the main target. As a ‘‘mechanical’’ means, post-conditioning has already been tried in man with encouraging results. Phar- macologic interventions that could be of promise are sta- tins, insulin, peptide hormones, including erythropoietin, fibroblast growth factor, and many others. (b) The patient with chronic coronary artery disease offers another para- digm, with the target of avoidance of further myocyte loss through apoptosis and inflammation. Various pharmaco- logic agents may prove useful in this context, together with exercise and ‘‘mechanical’’ improvement of cardiac function with attenuation of myocardial stretch, which by itself is a noxious influence. A continuous effort toward acute and chronically preserving myocardial integrity is a concept concerning both the researcher and the clinician. Keywords Myocardial protection Á Ischemic preconditioning Á Pharmacological preconditioning Á Postconditioning Á Acute myocardial infarction Á Ischemia- reperfusion injury Background Death from cardiac disorders is the greatest cause of mortality in western societies. It stems from two main sources, dysrhythmias and derangement of cardiac func- tion. The two are frequently interrelated. A main cause of cardiac dysfunction is acute or chronic loss of contractile tissue. The former may bring rapid death but may also lead to the latter, which is characterized by a progressive and inexorable course. Myocardial protection aims at reducing acute or chronic loss of myocardium. It should be stressed that even in the current era of the quest of cardiac regeneration, myocardial preservation retains its importance, because greater struc- tural integrity provides a more robust basis for the homing and beneficial action of whatever agents may be employed. Myocardial protection concerns both the researcher and the clinician. Actually, in contemporary medical practice basic research should fruitfully translate into clinical practice. In this context, from an integrated view point, myocar- dial protection can be effected through numerous ap- proaches: • Through the deletion or replacement of pathological genes. This aspect lies beyond the scope of the present review. • Through the administration of various substances. • Through enhancement of the organism’s intrinsic cardioprotective mechanisms. The last two aspects can well be complementary and reciprocal. We will first address the last aspect, because its description will set the stage for the better understanding of the action of exogenously delivered substances. D. V. Cokkinos (&) 1st Cardiology Department Onassis Cardiac Surgery Center, Athens, Greece e-mail: cokkino1@otenet.gr C. Pantos Department of Pharmacology, University of Athens, Athens, Greece 123 Heart Fail Rev (2007) 12:345–362 DOI 10.1007/s10741-007-9030-5