Reperfusion Injury in Patients With Acute Myocardial Infarction: JACC Scientific Statement.

Navin K Kapur, Stavros G Drakos, Borja Ibanez, George Dangas, Pasquale Pagliaro, Claudia Penna, Wayne Batchelor, Frederick G P Welt, J Richard Spears

Journal: Journal of the American College of Cardiology 2024;83(22):2196-2213

PMID: 38811097

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Abstract

Despite impressive improvements in the care of patients with ST-segment elevation myocardial infarction, mortality remains high. Reperfusion is necessary for myocardial salvage, but the abrupt return of flow sets off a cascade of injurious processes that can lead to further necrosis. This has been termed myocardial ischemia-reperfusion injury and is the subject of this review. The pathologic and molecular bases for myocardial ischemia-reperfusion injury are increasingly understood and include injury from reactive oxygen species, inflammation, calcium overload, endothelial dysfunction, and impaired microvascular flow. A variety of pharmacologic strategies have been developed that have worked well in preclinical models and some have shown promise in the clinical setting. In addition, there are newer mechanical approaches including mechanical unloading of the heart prior to reperfusion that are in current clinical trials.

Address: Department of Medicine, Division of Cardiovascular Medicine, University of Utah Hospital, Salt Lake City, Utah, USA. Electronic address: [email protected].; Inova Schar Heart and Vascular, Fairfax, Virginia, USA.; Department of Cardiovascular Medicine, Beaumont Systems, Royal Oak, Michigan, USA.; Department of Clinical and Biological Sciences, University of Torino, Turin, Italy.; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain; Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain.; Department of Medicine, Division of Cardiovascular Medicine, University of Utah Hospital, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA.; Division of Cardiology, Mount Sinai Health System, New York, New York, USA.; The CardioVascular Center and Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA.

DOI: 10.1016/j.jacc.2024.02.056

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MeSH Terms: Humans, Myocardial Reperfusion Injury, Myocardial Infarction, Myocardial Reperfusion, ST Elevation Myocardial Infarction