New Interventional Therapies beyond Stenting to Treat ST-Segment Elevation Acute Myocardial Infarction

Abstract

Myocardial infarction remains the principal cause of death in Europe. In patients with ST-segment-elevation myocardial infarction (STEMI), a promptly revascularization with primary percutaneous intervention (PCI) has transformed prognosis in the last decades. However, despite increasing successful PCI procedures, mortality has remained unchanged in recent years. Also, due to an unsatisfactory reperfusion, some patients have significant myocardial damage and suffer left ventricular adverse remodeling with reduced function—all that resulting in the onset of heart failure with all its inherent clinical and socioeconomic burden. As a consequence of longer ischemic times, distal thrombotic embolization, ischemia-reperfusion injury and microvascular dysfunction, the resultant myocardial infarct size is the major prognostic determinant in STEMI patients. The improved understanding of all the pathophysiology underlying these events has derived to the development of several novel therapies aiming to reduce infarct size and to improve clinical outcomes in these patients. In this article, based on the mechanisms involved in myocardial infarction prognosis, we review the new interventional strategies beyond stenting that may solve the suboptimal results that STEMI patients still experience.

Rodent Models of Dilated Cardiomyopathy and Heart Failure for Translational Investigations and Therapeutic Discovery

“…Thanks to the advancement of emergency care, most of the patients that present with an acute myocardial infarction with ST-elevation can now benefit from a prompt revascularization strategy [ 135 ]. Despite successful revascularization, up to 20% of patients surviving an ST-elevation myocardial infarction are hospitalized with HF in the first year after the event [ 136 ]. After revascularization, the underlying pathophysiological basis of myocardial damage switches from irreversible ischemia and cell necrosis to transient ischemia and ischemia-reperfusion injury.…”

Do We Really Need Aspirin Loading for STEMI?

“…Multiple studies have described worsening necrosis after reperfusion, so-called "reperfusion injury". After major achievements in shortening the time to reperfusion and establishing complete reperfusion by pPCI, efforts are being made to minimize "ischemia-reperfusion" and "reperfusion" injury, using interventions started before, during and immediately after reperfusion [9,10]. Many agents and interventions have shown beneficial effects in decreasing reperfusion injury in animal models but have failed to show positive impact in patients with STEMI [11][12][13].…”

Device‐Based Approaches Targeting Cardioprotection in Myocardial Infarction: The Expanding Armamentarium of Innovative Strategies

“…Then, the balloon is deflated allowing systolic venous drainage (Figure 4 ). 73 The capacity of these techniques to provide cardioprotection relies on several aspects. First, canine models have shown that increasing coronary sinus pressure allows redistribution of blood flow to the endocardial layers.…”

“…The catheter, which is connected to a console, is able to monitor coronary sinus pressure and automatically repeat inflations and deflations. Reproduced from Vidal‐Calés et al 73 under the terms and conditions of the Creative Commons Attribution (CC‐BY) license (https://creativecommons.org/licenses/by/4.0/).…”