Postconditioning: A New Paradigm for Myocardial Protection?

In patients with acute myocardial infarction, prompt restoration of blood flow is essential for myocardial salvage. However, the means by which reperfusion is initiated may play a crucial role in determining cardiomyocyte survival and, ultimately, clinical outcome. The newly described phenomenon of 'postconditioning' represents a modification of early reperfusion, whereby the first few moments of reflow are 'stuttered'. This simple alteration of reflow hemodynamics has recently been shown to significantly reduce infarct size in experimental models. Our aims in this mini-review are to: (1) highlight the emerging insights into the characteristics and cellular mechanisms of postconditioning-induced cardioprotection; and (2) discuss the potential clinical applications, such as controlled reperfusion during cardiac catheterization, of postconditioning.