Treatment of myocardial ischaemia-reperfusion injury in patients with ST-segment elevation myocardial infarction: promise, disappointment, and hope.

Autor:	He J; Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and University of Exeter, College of Medicine and Health, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK.; Department of Cardiology, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK., Bellenger NG; Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and University of Exeter, College of Medicine and Health, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK.; Department of Cardiology, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK., Ludman AJ; Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and University of Exeter, College of Medicine and Health, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK.; Department of Cardiology, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK., Shore AC; Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and University of Exeter, College of Medicine and Health, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK.; NIHR Exeter Clinical Research Facility, Royal Devon & Exeter NHS Foundation Trust and University of Exeter, College of Medicine and Health, RILD building, Royal Devon & Exeter Hospital, EX2 5DW Exeter, UK., Strain WD; Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and University of Exeter, College of Medicine and Health, Royal Devon & Exeter Hospital, EX2 5AX Exeter, UK.; NIHR Exeter Clinical Research Facility, Royal Devon & Exeter NHS Foundation Trust and University of Exeter, College of Medicine and Health, RILD building, Royal Devon & Exeter Hospital, EX2 5DW Exeter, UK.
Jazyk:	angličtina
Zdroj:	Reviews in cardiovascular medicine [Rev Cardiovasc Med] 2022 Jan 17; Vol. 23 (1), pp. 23.
DOI:	10.31083/j.rcm2301023
Abstrakt:	Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide. Timely reperfusion with primary percutaneous coronary intervention (PPCI) remains the gold standard in patients presenting with ST-segment elevation myocardial infarction (STEMI), limiting infarct size, preserving left ventricular ejection fraction (LVEF), and improving clinical outcomes. Despite this, a significant proportion of STEMI patients develop post-infarct heart failure. We review the current understanding and up-to-date evidence base for therapeutic intervention of ischaemia-reperfusion injury (IRI), a combination of myocardial ischaemia secondary to acute coronary occlusion and reperfusion injury leading to further myocardial injury and cell death. Multiple treatment modalities have been shown to be cardioprotective and reduce IRI in experimental animal models. Recent phase II/III randomised controlled trials (RCT) have assessed multiple cardioprotective strategies ranging from ischaemic conditioning, therapeutic hypothermia and hyperoxaemia to pharmacological therapies. While several therapies have been shown to reduce infarct size in animal models or proof-of-concept studies, many larger scale trial results have proven inconsistent and disappointing. Hard clinical outcomes remain elusive. We discuss potential reasons for the difficulties in translation to clinical practice. Competing Interests: The authors declare no conflict of interest. (© 2022 The Author(s). Published by IMR Press.)
Databáze:	MEDLINE
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