Myocardial response to ischemic preconditioning: is it a novel predictor of prognosis?

Ischemic preconditioning (IP) was originally defined as the enhancement of myocardial tolerance against infarction induced by a brief sublethal episode of ischemia in experimental animals (1,2). Subsequently, the concept of IP was expanded and currently includes protection against myocardial stunning, arrhythmia, and vascular dysfunction after ischemia/reperfusion injury (3–6). Results of clinical studies conducted over the past decade support the notion that IP occurs in human hearts, with one such situation being pre-infarct angina, which has been shown to protect patients with myocardial infarction in terms of infarct size, contractile dysfunction, vascular response to thrombolytic agents, and prognosis (7–11).