Myocardial ischemia-reperfusion injury causes further necrosis after flow restoration, prompting the development of new pharmacologic and mechanical unloading strategies currently in clinical trials.
This review highlights the mechanisms of myocardial ischemia-reperfusion injury in STEMI patients and outlines emerging pharmacologic and mechanical strategies to mitigate it.
Despite impressive improvements in the care of patients with ST-segment elevation myocardial infarction, mortality remains high. Reperfusion is necessary for myocardial salvage, but the abrupt return of flow sets off a cascade of injurious processes that can lead to further necrosis. This has been termed myocardial ischemia-reperfusion injury and is the subject of this review. The pathologic and molecular bases for myocardial ischemia-reperfusion injury are increasingly understood and include injury from reactive oxygen species, inflammation, calcium overload, endothelial dysfunction, and impaired microvascular flow. A variety of pharmacologic strategies have been developed that have worked well in preclinical models and some have shown promise in the clinical setting. In addition, there are newer mechanical approaches including mechanical unloading of the heart prior to reperfusion that are in current clinical trials.
Welt et al. (Mon,) conducted a review in Acute Myocardial Infarction. Myocardial ischemia-reperfusion injury causes further necrosis after flow restoration, prompting the development of new pharmacologic and mechanical unloading strategies currently in clinical trials.