Abstract
Myocardial infarction remains the principal cause of death in Europe. In patients with ST-segment-elevation myocardial infarction (STEMI), a promptly revascularization with primary percutaneous intervention (PCI) has transformed prognosis in the last decades. However, despite increasing successful PCI procedures, mortality has remained unchanged in recent years. Also, due to an unsatisfactory reperfusion, some patients have significant myocardial damage and suffer left ventricular adverse remodeling with reduced function—all that resulting in the onset of heart failure with all its inherent clinical and socioeconomic burden. As a consequence of longer ischemic times, distal thrombotic embolization, ischemia-reperfusion injury and microvascular dysfunction, the resultant myocardial infarct size is the major prognostic determinant in STEMI patients. The improved understanding of all the pathophysiology underlying these events has derived to the development of several novel therapies aiming to reduce infarct size and to improve clinical outcomes in these patients. In this article, based on the mechanisms involved in myocardial infarction prognosis, we review the new interventional strategies beyond stenting that may solve the suboptimal results that STEMI patients still experience.
Highlights
Primary percutaneous coronary intervention (PCI) has dramatically improved prognosis of patients with ST-segment-elevation myocardial infarction (STEMI) over the last decades [1] and it is considered the cornerstone of STEMI treatment [2]
Primary PCI has greatly improved outcomes in patients with myocardial infarction and it is considered essential in STEMI treatment, a remarkable group of patients still suffer significant myocardial damage with substantial mortality and morbidity in the context of the later development of heart failure due to ventricular dysfunction
This poorer prognosis is mainly related to the extent of infarct size
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Several factors play an important role on infarct size extension: ischemic time, distal embolization, microvascular dysfunction, and reperfusion injury [7] All these mechanisms are related to infarct size and worse outcomes so they have been studied as therapeutic targets. To address this unmet therapeutic need, multiple pharmacological and interventional strategies have been developed in recent years. These novel techniques aim to reduce infarct size, to preserve ventricular function and to change prognosis of STEMI patients. We provide an overview of different innovative interventional therapies—beyond primary PCI—for potentially improving outcomes in STEMI patients
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