Ischaemic Postconditioning: from Bench to Bedside

The increase in the incidence of ischaemic heart disease and acute myocardial infarction (AMI) in both high- and low-income countries necessitates the development of myocardial salvaging/protection interventions, to be applied alongside standard reperfusion therapies. Although the phenomenon of ischaemic preconditioning (IPC) is associated with the desired protective capacity, the necessity of its application before sustained ischaemia limits its clinical potential. The recently described phenomenon of postconditioning (postC), or short cycles of reperfusion/ischaemia applied at the onset of reperfusion, falls within the clinically relevant time period of reperfusion, but can it elicit reliable and potent cardioprotection? The answer to this problem is intimately related to the question whether postC can be translated from a laboratory technique to a clinical therapy. In this brief overview of postconditioning, the experimental set-ups and postC algorithms utilised, and their associated outcomes in all animal models studied (dog, rabbit, mouse, rat and pig) are discussed. The therapeutic potential of postC is also addressed by discussing reported preliminary studies on the efficacy and feasibility of postC (both ischaemic and pharmacological) in humans.