Table 3

Pharmacological conditioning: overview of clinical studies demonstrating an protective effect of pharmacological conditioning in patients with STEMI undergoing primary PCI

Strategy and studyTreatmentNMain resultsRemarks
 Kloner et al303 h intravenous infusion at high or low dose started before PCI or at time of thrombolysis2118Reduced mortality and infarct size in patients with duration of symptoms <3.17 h treated with thrombolysisAll TIMI flows. PCI in 40%
 Garcia-Dorado et al25Intracoronary bolus adenosine before PCI201No difference in infarct size by CMRRelative 27% reduction in infarct size in the patients with duration of symptoms <200 min
Atrial natriuretic peptide
 Kitakaze et al2972 h intravenous infusion started before PCI56915% relative reduction in AUC of CK and 2% absolute increase in LVEF. Reduced cardiac death and heart failure (HR 0.27)All TIMI flows
 Hallen et al26Intravenous bolus before and during PCI23450% relative reduction in infarct size in the subgroup of patients with duration of symptom <3 h, but no effect in the overall population
Cyclosporin A
 Piot et al22Intravenous bolus before PCI5840% relative reduction in AUC of CK. 20% relative reduction in infarct size by CMR. Smaller infarct size adjusted for AAR. No difference in LVEF
Glucose–insulin–potassium (GIK)
 Selker et al3212 h intravenous infusion started before PCI in the prehospital phase357No difference in progression to infarction. In patients with STEMI, 75% relative reduction in infarct size by SPECT and smaller in-hospital mortality and cardiac arrest (HR 0.39)Patients with suspected acute coronary syndrome were included
 Lønborg et al236 h intravenous infusion started 15 minutes before PCI10515% increase in myocardial salvage by CMR and reduced infarct size adjusted for AAR. No significant difference in infarct size, troponin I or LVEF30% relative reduction in infarct size in patients with system delay <132 min
 Bernink et al2472 h intravenous infusion started before PCI39No difference in infarct size/AAR. 26% relative reduction in infarct size/AAR ratio (p=0.09) by CMR in patients with TIMI 0/1 (n=23)
 Woo et al33Intravenous and subcutaneous bolus before PCI and subcutaneous bolus for 2 days5850% relative reduction in infarct size by CMR. Reduction in AUC of troponin I and CKMB. Improvement in global longitudinal strain and e/é. No effect on LVEF
 Ibanez et al27Intravenous bolus before PCI22019% relative reduction in infarct size by CMR and 3% absolute increase in LVEF. Peak and AUC CK was also reduced and myocardial salvage increased. 4% absolute increase in LVEF at 6 months and reduced admission for heart failure (HR 0.32)Only Killip class 1 or 2 and anterior infarction. The effect was only seen among patients with pre-PCI TIMI flow 0 or 1
 Jones et al28Intracoronary bolus of sodium nitrite before PCI8019% relative increase in salvage index by CMR. No difference in infarct size or AUC CK or troponin T. Significantly smaller infarct size among patients with TIMI 0/1All TIMI flows
  • AAR, area at risk; AUC, area under the curve; CK-MB, creatine kinase myoglobin band; CMR, cardiovascular magnetic resonance; LAD, left anterior descending artery; LVESV, LV end systolic volume; mPTP, mitochondrial permeability transition pore; MVO, microvascular obstruction; PCI, percutaneous coronary intervention; RCA, right coronary artery; SPECT, single-proton emission CT; STEMI, ST-segment elevation myocardial infarction; TIMI, thrombolysis in myocardial infarction.