Abstract
Optimal medical therapy for secondary prevention following acute myocardial infarction reduces non-fatal ischaemic events. Intensive antithrombotic or lipid-lowering approaches have failed to significantly lower mortality. In the past, reduction of infarct size in patients undergoing primary percutaneous revascularisation for acute myocardial infarction had been considered as a surrogate outcome marker. However, infarct size measured by magnetic resonance imaging or SPECT is strongly associated with all-cause mortality and hospitalization for heart failure within the first year after an acute myocardial infarction. Intracoronary administration of super-saturated oxygen (SSO2) immediately after revascularisation is an approach that can be used to reduce infarct size and, therefore, improve cardiovascular outcome in patients with acute myocardial infarction. In this article, we describe the modulation of pathophysiology by SSO2, review the existing trial data and present our first impressions with the technique in real clinical practice.
Highlights
Acute myocardial infarction (MI) is one of the major contributors to cardiovascular morbidity and mortality
In the acute phase of ST-elevation MI (STEMI), ventricular arrhythmias and cardiogenic shock are the main drivers of mortality contributing to inhospital mortality of approximately 10% and time from first medical contact to primary percutaneous coronary intervention (PCI) is a strong predictor of an adverse outcome [1]
Several interventions were recently described aiming for reduction in infarct size following acute STEMI, because animal data suggest that almost half of the infarct size might be attributable to reperfusion injury [10,11]
Summary
Acute myocardial infarction (MI) is one of the major contributors to cardiovascular morbidity and mortality. A meta-analysis of 10 randomized primary PCI trials including more than 2500 STEMI patients showed that infarct size measured within 1 month by cardiac magnetic resonance (CMR) imaging or technetium-99m sestamibi single-photon emission computed tomography (SPECT) was strongly associated with all-cause mortality and hospitalization for heart failure within 1 year [9]. This finding resulted in infarct size being accepted as a surrogate parameter of adverse clinical outcome. Several interventions were recently described aiming for reduction in infarct size following acute STEMI, because animal data suggest that almost half of the infarct size might be attributable to reperfusion injury [10,11]
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