Does reperfusion induce myocardial necrosis?

While coronary thrombolytic therapy in clinical practice is well established for acute myocardial infarction, the injury associated with reperfusion ("reperfusion injury") is still under intense investigation regarding its nature and the strategy for its prevention. Reperfusion injury has been defined as cell injury caused by reperfusion itself, in contradistinction to cell injury caused by the preceding ischemia. It refers to cell necrosis or is used in a broader way to include mechanical dysfunction (myocardial stunning), arrhythmia (reperfusion arrhythmia) and vascular damage (no-reflow phenomenon).1 In contrast to myocardial stunning, reperfusion arrhythmia and no-reflow phenomenon, the existence of reperfusion-induced lethal myocardial injury is still highly controversial.