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Review
Reducing myocardial infarct size: challenges and future opportunities
  1. Heerajnarain Bulluck1,2,
  2. Derek M Yellon1,2,
  3. Derek J Hausenloy1,2,3,4
  1. 1The Hatter Cardiovascular Institute, University College London, London, UK
  2. 2The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
  3. 3National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
  4. 4Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
  1. Correspondence to Professor Derek Hausenloy, Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore 169857, Singapore; derek.hausenloy{at}duke-nus.edu.sg

Abstract

Despite prompt reperfusion by primary percutaneous coronary intervention (PPCI), the mortality and morbidity of patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) remain significant with 9% death and 10% heart failure at 1 year. In these patients, one important neglected therapeutic target is ‘myocardial reperfusion injury’, a term given to the cardiomyocyte death and microvascular dysfunction which occurs on reperfusing ischaemic myocardium. A number of cardioprotective therapies (both mechanical and pharmacological), which are known to target myocardial reperfusion injury, have been shown to reduce myocardial infarct (MI) size in small proof-of-concept clinical studies—however, being able to demonstrate improved clinical outcomes has been elusive. In this article, we review the challenges facing clinical cardioprotection research, and highlight future therapies for reducing MI size and preventing heart failure in patients presenting with STEMI at risk of myocardial reperfusion injury.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2015-307855

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