Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA.
Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA.
Nat Rev Cardiol. 2017 Nov;14(11):679-693. doi: 10.1038/nrcardio.2017.102. Epub 2017 Jul 27.
Early coronary artery reperfusion improves outcomes for patients with ST-segment elevation myocardial infarction (STEMI), but morbidity and mortality after STEMI remain unacceptably high. The primary deficits seen in these patients include inadequate pump function, owing to rapid infarction of muscle in the first few hours of treatment, and adverse remodelling of the heart in the months that follow. Given that attempts to further reduce myocardial infarct size beyond early reperfusion in clinical trials have so far been disappointing, effective therapies are still needed to protect the reperfused myocardium. In this Review, we discuss several approaches to preserving the reperfused heart, such as therapies that target the mechanisms involved in mitochondrial bioenergetics, pyroptosis, and autophagy, as well as treatments that harness the cardioprotective properties of inhaled anaesthetic agents. We also discuss potential therapies focused on correcting the no-reflow phenomenon and its effect on healing and adverse left ventricular remodelling.
早期冠状动脉再灌注可改善 ST 段抬高型心肌梗死（STEMI）患者的预后，但 STEMI 患者的发病率和死亡率仍然高得令人无法接受。这些患者的主要缺陷包括泵功能不足，这是由于在治疗的最初几个小时内肌肉迅速梗死，以及在随后的几个月中心脏发生不良重塑。鉴于在临床试验中，试图在早期再灌注的基础上进一步减少心肌梗死面积的尝试迄今令人失望，因此仍然需要有效的治疗方法来保护再灌注的心肌。在这篇综述中，我们讨论了几种保护再灌注心脏的方法，例如针对线粒体生物能学、细胞焦亡和自噬相关机制的治疗方法，以及利用吸入麻醉剂的心脏保护特性的治疗方法。我们还讨论了一些潜在的治疗方法，这些方法侧重于纠正无复流现象及其对愈合和不良左心室重塑的影响。
