Abstract
Cardioprotection has been defined as a therapy that limits the infarct size during an acute myocardial infarction that may lead to better clinical outcomes. Various interventions have been investigated in the past to reduce myocardial infarct size with variable success. The best strategy till date to limit infarct size has been the early restoration of coronary blood flow, with percutaneous coronary interventionwhere available. Stenting following invasive reperfusion, especially in the early hours after an infraction has been found superior to all other available modalities of therapy. Attempt to decrease time from onset of symptoms to start of reperfusion and maintaining vessel patency has been proven to yield the best outcomes. Future studies powered to better assess clinical outcomes are needed for adjunctive therapy with stem cells and hypothermia.
Highlights
Of the different modalities of re-establishing coronary blood flow after an acute myocardial infarction resulting from occlusion of a coronary vessel, angioplasty with stenting has been shown to be the best in terms of improved mortality and limiting infarct size [4,5]
Glucose-insulin-potassium infusion has been purported to reduce mortality and reduce infarct size, especially for diabetic patientshowever recent trials have thrown this hypothesis into serious question [14,15]
Adenosine or adenosine receptor agonists have been shown to reduce the extent of myocardial damage from AMI in some experimental studies [16] a definitive outcomes trial is still awaited
Summary
Cardioprotection has been defined as a therapy that limits the infarct size during an acute myocardial infarction that may lead to better clinical outcomes [1]. The best strategy till date to limit infarct size has been the early restoration of coronary blood flow, with percutaneous coronary interventionwhere available. Especially in the early hours after an infraction has been found superior to all other available modalities of therapy. Future studies powered to better assess clinical outcomes are needed for adjunctive therapy with stem cells and hypothermia. Assessment of infarct size following an acute myocardial infarction: Infarct sizes were traditionally assessed with electrocardiographic changes and blood biomarkers including cardiac enzymes. With the recent advances in cardiac imaging modalities, nuclear scans, echocardiography, as well as computed tomography and magnetic resonance imaging have become established modalities for assessment of infarct size [2,3]
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