On the Edge

Abstract

Coronary heart disease is an inflammatory disorder of the coronary vessels. With a prevalence of approximately 20% in the general population, it is an endemic problem in industrialized countries. It has been the leading cause of death in the past 80 years or so in the United States. Coronary heart disease may lead to acute coronary syndromes. These cover a wide spectrum of clinical presentations including unstable angina, non–ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction, and sudden cardiac death. The common anatomic substrate of acute coronary syndromes is coronary thrombosis or rupture of an atherosclerotic plaque leading to an obstruction of the vessel and subsequent ischemia in the corresponding myocardial area. Thus, prompt reperfusion by primary percutaneous coronary intervention or fibrinolysis combined with early percutaneous coronary intervention is the gold standard in treatment to improve clinical outcome.1–3 Adjuvant treatment measures include antiplatelet agents, anticoagulants, and anti-ischemic therapy together with analgesic agents, to restore blood flow and diminish myocardial necrosis associated with prolonged ischemia. Article see p 279 However, restoration of blood flow alone is not sufficient because loss of viable myocardium is augmented by ischemia/reperfusion (I/R) injury despite target vessel revascularization. In the current issue of Circulation: Cardiovascular Interventions , Arslan and his colleagues4 present a promising adjuvant strategy to deal with I/R injury after myocardial infarction. An important aspect of I/R injury is the development of an inflammatory response after restoration of blood flow and the influx of immune cells into the infarcted area that may lead to additional damage to the myocardium. The innate immune system plays a pivotal role in the development of inflammation after reperfusion. Within the innate immune system, various so-called pattern recognition receptors exist, and within the pattern recognition receptors, the Toll-like receptors (TLRs) are characterized best. ### A Brief History of TLRs These evolutionary, …