title: Reducing myocardial infarct size: challenges and future opportunities.
abstract: Despite prompt reperfusion by primary percutaneous coronary intervention (PPCI), the mortality and morbidity of patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) remain significant with 9% death and 10% heart failure at 1 year. In these patients, one important neglected therapeutic target is 'myocardial reperfusion injury', a term given to the cardiomyocyte death and microvascular dysfunction which occurs on reperfusing ischaemic myocardium. A number of cardioprotective therapies (both mechanical and pharmacological), which are known to target myocardial reperfusion injury, have been shown to reduce myocardial infarct (MI) size in small proof-of-concept clinical studies-however, being able to demonstrate improved clinical outcomes has been elusive. In this article, we review the challenges facing clinical cardioprotection research, and highlight future therapies for reducing MI size and preventing heart failure in patients presenting with STEMI at risk of myocardial reperfusion injury.
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D000818:Animals; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D057775:Ischemic Postconditioning / Q000009:adverse effects / Q000379:methods*; D019194:Ischemic Preconditioning / Q000009:adverse effects / Q000379:methods*; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents