Update on Cardioprotective Strategies for STEMI

Kloner, Robert A.; Creech, Jeffrey; Stone, Gregg W.; O'Neil, W.W.; Burkhoff, Daniel; Spears, J. Richard

doi:10.1016/j.jacbts.2021.07.011

Cited by 21 publications

(16 citation statements)

References 53 publications

(82 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Exposure to hyperoxia for a short period of time before experimental ischemia induces a mild systemic oxidative stress, which induces a preconditioning-like cardioprotection, reduces the infarction area and arrhithmia [ 13 , 22 , 33 , 34 ]. In patients with ST-segment elevation myocardial infarction undergoing coronary artery stenting, infusion of supplemental oxygen directly into the left anterior descending artery (the infarct-related artery) resulted in a reduction in infarct size [ 35 , 36 , 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Endothelial Function and Hypoxic–Hyperoxic Preconditioning in Coronary Surgery with a Cardiopulmonary Bypass: Randomized Clinical Trial

et al. 2023

View full text Add to dashboard Cite

A hypoxic–hyperoxic preconditioning (HHP) may be associated with cardioprotection by reducing endothelial damage and a beneficial effect on postoperative outcome in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Patients (n = 120) were randomly assigned to an HHP and a control group. A safe, inhaled oxygen fraction for the hypoxic preconditioning phase (10–14% oxygen for 10 min) was determined by measuring the anaerobic threshold. At the hyperoxic phase, a 75–80% oxygen fraction was used for 30 min. The cumulative frequency of postoperative complications was 14 (23.3%) in the HHP vs. 23 (41.1%), p = 0.041. The nitrate decreased after surgery by up to 20% in the HHP group and up to 38% in the control group. Endothelin-1 and nitric oxide metabolites were stable in HHP but remained low for more than 24 h in the control group. The endothelial damage markers appeared to be predictors of postoperative complications. The HHP with individual parameters based on the anaerobic threshold is a safe procedure, and it can reduce the frequency of postoperative complications. The endothelial damage markers appeared to be predictors of postoperative complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Endothelial Function and Hypoxic–Hyperoxic Preconditioning in Coronary Surgery with a Cardiopulmonary Bypass: Randomized Clinical Trial

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Despite positive results in preclinical models, these modalities have been largely ineffective in clinical trials. (28,31,32) Supersaturated oxygen (SSO2) therapy is the only adjunct device or drug demonstrated in an adequately powered randomized trial to reduce infarct size in STEMI patients treated with primary PCI and stenting. (33) A recent review details the effects of this therapy at the myocardial cell and microvascular level.…”

Section: Discussionmentioning

confidence: 99%

“…(33) A recent review details the effects of this therapy at the myocardial cell and microvascular level. (32) SSO2 therapy is FDA approved for intracoronary delivery after left anterior descending artery stenting for STEMI and is currently undergoing further investigation for expanded indications including in the unmet need of cardiogenic shock. Other modalities to address reperfusion injury including mechanical unloading, cooling therapies, and the delivery of other novel pharmaceutical agents require further study.…”

Section: Discussionmentioning

confidence: 99%

The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

Martin

2022

Preprint

View full text Add to dashboard Cite

Background There is limited data on temporal trends in clinical outcomes after ST–segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) particularly beyond one year and in real world populations that include patients often excluded from randomized trials. Objectives We sought to compare the temporal trends in the incidence of death and re–hospitalization for congestive heart failure (CHF) following anterior STEMI in a Medicare cohort of beneficiaries treated with primary PCI in 2005 (n = 1,479) with those treated in 2016 through quarter (Q) 2 of 2017 (n = 22,432). Methods Outcomes were examined using both descriptive and regression analysis to control for differences in patient clinical characteristics over time. Results The 1–year mortality rate trended higher in the late cohort (10.3 vs 8.9%, p=0.068). The 2–year mortality rate was significantly higher in the late cohort (14.5 vs 11.4%, p <0.01). The one–year re–hospitalization for CHF was lower in the late cohort (10.6 versus 16.7%, p <0.01), but the 2–year rate was unchanged (19.3 vs 20.7%, p=0.55). After adjustment for covariates with two models there were highly statistically significant increases in mortality at 1–year (2.3 – 4.1%) and 2–years (4.2 – 6.5%) in the late cohort. The unadjusted trends in re–hospitalization for CHF persisted after adjustment for covariates. Conclusions Despite prior improvements in STEMI outcomes in the reperfusion era related to the broad adoption of timely PCI, there is a persistent high mortality and CHF burden in patients with anterior STEMI. New strategies that address reperfusion injury and enhance myocardial salvage are needed.

show abstract

“…Lastly, a study regarding updates on cardioprotective strategies for STEMI was a multicenter study of 29 patients with acute STEMI reperfused with primary PCI, in which hypoxemic blood was infused for 60 to 90 min, right after proximal patency was established. The hypoxemic reperfusion was accomplished successfully in all of the patients, without therapy-related adverse events [ 62 , 105 ]. An echocardiographic study carried out on the patients showed an improvement in the wall motion score index and a trend toward an increase in mean left ventricular ejection fraction (LVEF) at 24 hours; approximately 48.6% improved immediately after angioplasty, against a 51.8% improvement after 24 hours.…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

“…An echocardiographic study carried out on the patients showed an improvement in the wall motion score index and a trend toward an increase in mean left ventricular ejection fraction (LVEF) at 24 hours; approximately 48.6% improved immediately after angioplasty, against a 51.8% improvement after 24 hours. After a month, the wall motion score and the LVEF improved by about 54.4%, and at 3 months it improved by 56% [ 62 ]. These clinical studies have been able to demonstrate that the SSO 2 therapy is a safe and successful agent to apply with reperfusion, in order to reduce infarct size, preserve cardiac function, reduce adverse LV remodeling, and, more likely, to improve most clinical outcomes in patients with acute anterior STEMI reperfused within 6 hours of symptoms as possible [ 62 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

View full text Add to dashboard Cite

In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.

show abstract

Update on Cardioprotective Strategies for STEMI

Cited by 21 publications

References 53 publications

Endothelial Function and Hypoxic–Hyperoxic Preconditioning in Coronary Surgery with a Cardiopulmonary Bypass: Randomized Clinical Trial

Endothelial Function and Hypoxic–Hyperoxic Preconditioning in Coronary Surgery with a Cardiopulmonary Bypass: Randomized Clinical Trial

The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

Contact Info

Product

Resources

About