Background: Experimental studies of acute myocardial infarction have revealed that up to
half of the final infarct size may be due to reperfusion injury rather than the initial ischemic incident.
Research over the past three decades has deepened our understanding of the molecular mechanisms
underlying ischemic reperfusion injury and several therapeutic strategies to decrease the incidence and
severity of reperfusion injury have been explored.
Objective: To discuss the promising therapies and future perspectives on methods to attenuate myocardial
Results: Existing therapies that address reperfusion can be divided into two major groups comprising
nonpharmacological and pharmacological interventions. Myriad pharmacological and nonpharmacological
approaches to reduce lethal reperfusion injury have been employed. Although many
initial clinical studies were negative, more recent proof-of-concept clinical trials are promising. To
date, the most encouraging results are with ischemic postconditioning, remote ischemic preconditioning,
ANP, adenosine, cyclosporine and exenatide.
Conclusion: Studies demonstrate that nonpharmacological and pharmacological conditioning can be
used together as part of a multifaceted approach to improve clinical outcomes in patients with
ischemic heart disease.