Zalewski Jaroslaw, Nowak Karol, Furczynska Patrycja, Zalewska Magdalena
Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, 80 Pradnicka Street, 31-202 Krakow, Poland.
Department of Emergency Medicine, Faculty of Health Science, Jagiellonian University Medical College, Michalowskiego 12 Street, 31-126 Krakow, Poland.
J Clin Med. 2021 Dec 16;10(24):5904. doi: 10.3390/jcm10245904.
Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.
直接经皮冠状动脉腔内血管成形术进行机械再灌注，作为急性心肌梗死（MI）的首选治疗方法，不仅与较高比例的完全心外膜和组织再灌注相关，而且与非常良好的近期和长期临床结果相关。然而，MI治疗的致命弱点是其一系列并发症，如由于严重收缩和/或舒张功能障碍导致的心源性休克或MI机械并发症，包括左心室游离壁穿孔、伴急性二尖瓣反流的乳头肌破裂和室间隔破裂。它们与死亡率增加相关，有时甚至与极高的死亡率相关，决定了MI患者群体的总体死亡率。在本综述中，我们总结了MI并发症的机制、当前的治疗管理以及克服其灾难性后果的替代方向。此外，我们试图指出当前治疗证据中的空白，作为进一步临床研究的潜在目标。从不改善的死亡率趋势来看，未来复杂MI的治疗管理将需要基于其全面病理生物学的个性化和新颖方法。
