Editor’s Choice- Pathophysiology and therapy of myocardial ischaemia/reperfusion syndrome

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.

Impacto de la COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia española

“…Por otra parte, los tiempos hasta la reperfusión fueron más largos, debido en gran parte a que los pacientes contactaron más tarde con el sistema de salud, ya que no se observaron diferencias en cuanto al tiempo entre el primer contacto médico y la reperfusión. El tiempo de isquemia es un factor determinante en el tamaño del infarto de los pacientes con IAMCEST, y la identificación rápida y la aplicación temprana del tratamiento agudo del IAMCEST son cruciales para reducir la morbilidad y la mortalidad 10 , 11 , 12 . Tiene interés señalar que la cohorte de COVID-19 mostró una prevalencia superior de antecedentes de enfermedad coronaria y tenía con más frecuencia una enfermedad multivaso, lo cual indica que los pacientes con antecedentes de cardiopatía isquémica pudieron haber sido menos reacios a acudir al hospital.…”

Development and Long-Term Follow-Up of an Experimental Model of Myocardial Infarction in Rabbits

“…Other advantages are the adaptivity of the experimental design to the objectives of the study and the use of direct and precise techniques to obtain the desired information. Nevertheless, there are also limitations derived from interspecies differences and the necessary extrapolation of the obtained results [7,10,11]. The reproducibility of the methodology and experimental conditions, as well as of the results, is another aspect that needs to be considered [10,11,27].…”

“…Cardiovascular disease, especially ischemic heart disease, is the leading cause of death nowadays [ 1 , 2 , 3 , 4 , 5 ], and global medium-term projections still consider ischemic heart disease as the most frequent [ 6 ]. Basic research and its transfer to the clinic are necessary to deepen the knowledge on the causes and mechanisms involved, as well as in the development and improvement of preventive, diagnostic, and therapeutic procedures to detect the disease in the preclinical stages, prevent its manifestations, and/or reduce the adverse effects [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…The use of animal models to study ischemic heart disease and, more specifically, the phenomena that characterize the processes of myocardial ischemia and reperfusion has provided a wide range of information. This information covers the molecular mechanisms and signaling pathways involved in the development of myocardial damage to the local and general regulatory mechanisms that can be modified to protect and limit the adverse consequences of the disease, including remodeling, ventricular dysfunction, cardiac arrhythmias, and sudden death [ 7 , 8 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Sudden cardiac death is a major public health problem.…”

Myocardial infarction in times of COVID-19

“…Although a longer ischemia time is associated with larger AMI, the relationship of this phenomenon with higher acute mortality is unclear. 3 Unfortunately, the registry lacks information on left ventricular ejection fraction, a parameter associated with AMI size and prognosis in STEMI patients. 4 …”