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Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

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,...

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Autores principales: Bellis, Alessandro, Di Gioia, Giuseppe, Mauro, Ciro, Mancusi, Costantino, Barbato, Emanuele, Izzo, Raffaele, Trimarco, Bruno, Morisco, Carmine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268641/
https://www.ncbi.nlm.nih.gov/pubmed/34279451
http://dx.doi.org/10.3390/jcm10132968
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author Bellis, Alessandro
Di Gioia, Giuseppe
Mauro, Ciro
Mancusi, Costantino
Barbato, Emanuele
Izzo, Raffaele
Trimarco, Bruno
Morisco, Carmine
author_facet Bellis, Alessandro
Di Gioia, Giuseppe
Mauro, Ciro
Mancusi, Costantino
Barbato, Emanuele
Izzo, Raffaele
Trimarco, Bruno
Morisco, Carmine
author_sort Bellis, Alessandro
collection PubMed
description 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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spelling pubmed-82686412021-07-10 Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy Bellis, Alessandro Di Gioia, Giuseppe Mauro, Ciro Mancusi, Costantino Barbato, Emanuele Izzo, Raffaele Trimarco, Bruno Morisco, Carmine J Clin Med Review 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. MDPI 2021-07-01 /pmc/articles/PMC8268641/ /pubmed/34279451 http://dx.doi.org/10.3390/jcm10132968 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bellis, Alessandro
Di Gioia, Giuseppe
Mauro, Ciro
Mancusi, Costantino
Barbato, Emanuele
Izzo, Raffaele
Trimarco, Bruno
Morisco, Carmine
Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy
title Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy
title_full Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy
title_fullStr Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy
title_full_unstemmed Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy
title_short Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy
title_sort reducing cardiac injury during st-elevation myocardial infarction: a reasoned approach to a multitarget therapeutic strategy
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268641/
https://www.ncbi.nlm.nih.gov/pubmed/34279451
http://dx.doi.org/10.3390/jcm10132968
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