Illusion of reperfusion. Does anyone achieve optimal reperfusion during acute myocardial infarction?
نویسندگان
چکیده
Thrombolytic therapy significantly improves the natural history of acute myocardial infarction, but recent data suggest that current reperfusion strategies have yet to realize the maximum potential for reduction of mortality and salvage of ventricular function. Coronary patency rates as high as 85% assessed by angiography 90 minutes after initiation of treatment greatly overestimate the efficacy of thrombolytic regimens, as this conventional angiographic "snapshot" view does not satisfactorily reflect the dynamic processes of coronary artery recanalization and reocclusion or the adequacy of myocardial perfusion. In fact, only the unusual patient appears to achieve optimal reperfusion for acute myocardial infarction, with a substantial deterioration of benefit in many patients due to insufficiently early or rapid recanalization, incomplete patency with TIMI grade 2 flow or critical residual coronary stenoses, absence of myocardial tissue reflow despite epicardial artery patency, intermittent coronary patency, subsequent reocclusion, or reperfusion injury. Recently developed techniques to critically assess the quality of reperfusion, coupled with the introduction of novel pharmacological agents and an improved understanding of the roles and mechanisms of existing thrombolytic and adjunctive drugs, have provided the opportunity to overcome many of the present limitations of reperfusion therapy. Emerging strategies to achieve optimal reperfusion are directed at enhancement of the velocity and quality of thrombolysis, amelioration of the adverse effects of reperfusion, and use of alternative pathways to myocardial salvage.
منابع مشابه
Prediction of long-term cardiac events by 123I-MIBG imaging after acute myocardial infarction and reperfusion therapy
Objective(s): In heart failure, the heart-to-mediastinum (H/M) ratio of the delayed image and washout rate (WR) are well-known as a powerful cardiac event predictors. H/M ratio quantifies the accumulation rate of MIBG in the myocardium and WR quantifies reduction of meta-iodobenzylguanidine (MIBG) accumulation in the heart from the early planar image to the delayed pla...
متن کاملEffects of Postconditioning, Preconditioning and Perfusion of L-carnitine During Whole Period of Ischemia/ Reperfusion on Cardiac Hemodynamic Functions and Myocardial Infarction Size in Isolated Rat Heart
متن کامل
Role of Fructose as a Potent Antiarrhythmic and Anti-infarct agent in Isolated Rat Heart
In the current study, effects of acute short term administration of fructose on cardiac arrhythmias and myocardial infarction size following ischemia/reperfusion were investigated in isolated rat heart. The hearts were subjected to 30 min zero flow global ischemia followed by 120 min reperfusion. In the control group, the hearts were perfused by normal drug free Krebs-Henseleit (K/H) solution t...
متن کاملRole of Fructose as a Potent Antiarrhythmic and Anti-infarct agent in Isolated Rat Heart
In the current study, effects of acute short term administration of fructose on cardiac arrhythmias and myocardial infarction size following ischemia/reperfusion were investigated in isolated rat heart. The hearts were subjected to 30 min zero flow global ischemia followed by 120 min reperfusion. In the control group, the hearts were perfused by normal drug free Krebs-Henseleit (K/H) solution t...
متن کاملRapid Spontaneous Coronary Artery Reperfusion Following Severe Bradycardia During Exercise Tolerance Test: A Rare Case Report
The acute occlusion of a coronary artery without the evidence of myocardial infarction might immediately affect both the diagnosis and treatment of coronary artery disease. We present the case with a sudden occlusion of the left main coronary artery without typical chest pain following an exercise tolerance test and rapid spontaneous reperfusion of the left main coronary artery.
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Circulation
دوره 88 3 شماره
صفحات -
تاریخ انتشار 1993