December 16, 2015Open Access
Reducing myocardial infarct size: challenges and future opportunities
Structured PICO
Do cardioprotective therapies reduce myocardial infarct size and improve clinical outcomes in patients presenting with STEMI?
P
Population
Patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) at risk of myocardial reperfusion injury
I
Intervention
Cardioprotective therapies (both mechanical and pharmacological) targeting myocardial reperfusion injury
O
Outcome
Myocardial infarct (MI) size and clinical outcomes (death, heart failure)
Despite success in reducing infarct size in small studies, cardioprotective therapies for STEMI patients have yet to demonstrate definitive improvements in hard clinical outcomes.
Abstract
Despite prompt reperfusion by primary percutaneous coronary intervention (PPCI), the mortality and morbidity of patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) remain significant with 9% death and 10% heart failure at 1 year. In these patients, one important neglected therapeutic target is 'myocardial reperfusion injury', a term given to the cardiomyocyte death and microvascular dysfunction which occurs on reperfusing ischaemic myocardium. A number of cardioprotective therapies (both mechanical and pharmacological), which are known to target myocardial reperfusion injury, have been shown to reduce myocardial infarct (MI) size in small proof-of-concept clinical studies-however, being able to demonstrate improved clinical outcomes has been elusive. In this article, we review the challenges facing clinical cardioprotection research, and highlight future therapies for reducing MI size and preventing heart failure in patients presenting with STEMI at risk of myocardial reperfusion injury.