title: Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments.
abstract: Despite major advances in mechanical and pharmacological reperfusion strategies to improve acute myocardial infarction (MI) injury, substantial mortality, morbidity, and socioeconomic burden still exists. To further reduce infarct size and thus ameliorate clinical outcome, the focus has also shifted towards early detection of MI with high-sensitive troponin assays, imaging, cardioprotection against pathophysiological targets of myocardial reperfusion injury with mechanical (ischaemic post-conditioning, remote ischaemic pre-conditioning, therapeutic hypothermia, and hypoxemia) and newer pharmacological interventions (atrial natriuretic peptide, cyclosporine A, and exenatide). Evidence from animal models of myocardial ischaemia and reperfusion also demonstrated promising results on more selective anti-inflammatory compounds that require additional validation in humans. Cardiac stem cell treatment also hold promise to reduce infarct size and negative remodelling of the left ventricle that may further improves symptoms and prognosis in these patients. This review focuses on the pathophysiology, detection, and reperfusion strategies of ST-segment elevation MI as well as current and future challenges to reduce ischaemia/reperfusion injury and infarct size that may result in a further improved outcome in these patients.
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, 6 Viale Benedetto XV, 16132 Genoa, Italy Division of Cardiology, Foundation for Medical Researches, Faculty of Medicine, University of Geneva, 64 avenue de la Roseraie, 1211 Geneva, Switzerland fabrizio.montecucco@unige.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: Division of Cardiology, Foundation for Medical Researches, Faculty of Medicine, University of Geneva, 64 avenue de la Roseraie, 1211 Geneva, Switzerland.
authors.forename: Federico
authors.initials: F
authors.lastname: Carbone
authors.affiliation: Department of Radiology, Johns Hopkins University, JHOC 3225, 601 N. Caroline Street, 21287 Baltimore, MD, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Schindler
mesh_terms: D000818:Animals; D006801:Humans; D057775:Ischemic Postconditioning; D019194:Ischemic Preconditioning; D015428:Myocardial Reperfusion Injury; D000072657:ST Elevation Myocardial Infarction
keywords: Acute myocardial infarction; Pathophysiology; Treatment