Inflammatory response post-myocardial infarction and reperfusion: a new therapeutic target?

Inflammation is a cornerstone of the post-myocardial infarction healing process. However, an exuberant systemic as well as loco-regional inflammatory response may have a direct deleterious effect on myocytes extending myocardial necrosis and thus altering long-term prognosis. For many years, this overwhelming inflammatory reaction has been proposed as pharmacological target. In animal models, encouraging results have been obtained. However, in human trials, none of the applied medications reached a convincing clinical impact. Nevertheless, this therapeutic strategy remains conceptually valid, especially in the era of reperfusion by percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). In this ischaemic setting, the inflammatory response in the peri-necrotic zone may extend the myocardial scar formation, thus playing an important prognostic role. Not surprisingly, the combination of available and new anti-inflammatory treatments, systemically administrated or locally applied, in association with primary PCI as reperfusion therapy is currently under intensive evaluation. Some promising preliminary results suggest that this treatment modality is likely to become standard care of AMI in the near future.