Abstract
There is a need to find interventions able to reduce the extent of injury in reperfused ST-segment elevation myocardial infarction (STEMI) beyond timely reperfusion. In this review, we summarise the clinical impact of STEMI from epidemiological, clinical and biological perspectives. We also revise the pathophysiology underlying the ischaemia/reperfusion syndrome occurring in reperfused STEMI, including the several players involved in this syndrome, such as cardiomyocytes, microcirculation and circulating cells. Interventions aimed to reduce the resultant infarct size, known as cardioprotective therapies, are extensively discussed, putting the focus on both mechanical interventions (i.e. ischaemic conditioning) and promising pharmacological therapies, such as early intravenous metoprolol, exenatide and other glucose modulators, N-acetylcysteine as well as on some other classic therapies which have failed to be translated to the clinical arena. Novel targets for evolving therapeutic interventions to ameliorate ischaemia/reperfusion injury are also discussed. Finally, we highlight the necessity to improve the study design of future randomised clinical trials in the field, as well as to select patients better who can most likely benefit from cardioprotective interventions.
Keywords:
Ischaemia/reperfusion injury; acute myocardial infarction; cardioprotection.
MeSH terms
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Acetylcysteine / administration & dosage
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Acetylcysteine / therapeutic use
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Acute Disease
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Administration, Intravenous
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Adrenergic beta-1 Receptor Antagonists / administration & dosage
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Adrenergic beta-1 Receptor Antagonists / therapeutic use
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Animals
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Cardiotonic Agents / therapeutic use
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Exenatide / administration & dosage
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Exenatide / therapeutic use
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Free Radical Scavengers / administration & dosage
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Free Radical Scavengers / therapeutic use
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Humans
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Hypoglycemic Agents / administration & dosage
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Hypoglycemic Agents / therapeutic use
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Incidence
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Metoprolol / administration & dosage
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Metoprolol / therapeutic use
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Mice
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Mice, Transgenic
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Microcirculation / physiology
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Models, Animal
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Myocardial Infarction / epidemiology
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Myocardial Infarction / physiopathology
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Myocardial Infarction / therapy*
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Myocardial Reperfusion Injury / drug therapy*
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Myocardial Reperfusion Injury / epidemiology
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Myocardial Reperfusion Injury / physiopathology*
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Myocytes, Cardiac / pathology
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Percutaneous Coronary Intervention / methods
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Randomized Controlled Trials as Topic
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ST Elevation Myocardial Infarction / drug therapy*
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ST Elevation Myocardial Infarction / epidemiology
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ST Elevation Myocardial Infarction / mortality
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ST Elevation Myocardial Infarction / physiopathology
Substances
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Adrenergic beta-1 Receptor Antagonists
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Cardiotonic Agents
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Free Radical Scavengers
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Hypoglycemic Agents
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Exenatide
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Metoprolol
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Acetylcysteine