Myocardial preconditioning. What have we learned?

It is now 10 years since the phenomenon termed 'ischaemic preconditioning' was formally recognised. The possibility that an innate mechanism of myocardial protection might be inducible in the human heart has generated considerable excitement and enthusiastic research. This has led to a more detailed understanding of the mechanisms underlying ischaemia-reperfusion injury and has provided reason to believe that the progress of myocardial necrosis might be modified by invoking a protective adaptation within the myocyte. Considerable progress has been made towards the identification of cell triggers and transduction mechanisms that may be involved in the process of preconditioning. It is likely that future studies will examine the effect of several classes of pharmacological agents that may prove capable of mimicking the protective effect of sub-lethal ischaemia.