[New strategies in cardioprotection during acute myocardial infarction: Impact of hypoxic nitrate-nitrite-NO signaling]

Acute myocardial infarction remains one of the leading causes of morbidity, mortality and disability in industrialized countries. After an acute myocardial infarction, early and successful myocardial reperfusion is the most effective strategy for reducing the size of a myocardial infarct and improving the clinical outcome. The process of restoring blood flow to the ischemic myocardium, however, can induce injury itself. This phenomenon, termed myocardial ischemia reperfusion injury (IRS), can paradoxically reduce the beneficial effects of myocardial reperfusion. In experimental studies a number of strategies have been shown to ameliorate lethal reperfusion injury. However, the translation of these beneficial effects into the clinical setting has been disappointing. Modulation of the hypoxic nitrate-nitrite-nitric oxide (NO) pathway may have the potential to challenge this problem. First translational studies are promising and clinical trials are ongoing.