期刊
JOURNAL OF CLINICAL MEDICINE
卷 10, 期 13, 页码 -出版社
MDPI
DOI: 10.3390/jcm10132968
关键词
left ventricular remodeling; extracellular matrix; remote ischemic conditioning; coronary microvascular obstruction; primary percutaneous coronary intervention
Reducing myocardial-ischemia reperfusion injury (MIRI) is crucial for improving prognosis in ST elevation myocardial infarction (STEMI) patients. While single interventions have shown benefits, a multitarget therapeutic strategy is needed to effectively reduce mortality.
The significant reduction in 'ischemic time' through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis.
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