Cardioprotection and pharmacological therapies in acute myocardial infarction: Challenges in the current era  

作　　者：Alberto Dominguez-Rodriguez Pedro Abreu-Gonzalez Russel J Reiter 

机构地区：[1]Department of Cardiology,Complejo Hospitalario Universitario de Canarias [2]Instituto Universitario de Tecnologías Biomédicas [3]Department of Physiology,University of La Laguna [4]Department of Cellular and Structural Biology,The University of Texas Health Science Center at San Antonio

出　　处：《World Journal of Cardiology》2014年第3期100-106,共7页世界心脏病学杂志（英文版）（电子版）

基　　金：Supported by Framework of one research project of the Spanish Society of Cardiology for Clinical Research in Cardiology 2012

摘　　要：In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease.In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease.

关 键 词：ST-elevation MYOCARDIAL infarction CARDIOPROTECTION MYOCARDIAL REPERFUSION injury INFARCT size ADJUNCTIVE therapy 

分 类 号：R542.22[医药卫生—心血管疾病]