Improving perfusion at reperfusion
نویسنده
چکیده
Early reperfusion of the ischemic myocardium has been shown to reduce mortality in acute myocardial infarction. Unfortunately, reperfusion, although necessary to relieve ischemia, may be followed by morphological, functional, and electrical changes that result in additional myocardial damage, known as reperfusion injury. In animal models, several pharmacologic agents and reperfusion strategies have been shown to be effective in preventing reperfusion injury, but most of these measures have failed when transferred to humans. Adenosine is one exception, because it has been shown to limit ischemiareperfusion damage in several animal models, and has been successfully tested in man. The administration of adenosine as an adjunct to primary percutaneous transluminal coronary angioplasty early in acute myocardial infarction improved myocardial blood flow, prevented the no-reflow phenomenon, reduced the incidence of adverse cardiac events, and improved recovery of ventricular function. More recently, favorable results have been reported with myocardial postconditioning. However, neither of these two therapeutic strategies has been definitively confirmed in man, and their use remains limited to research-oriented laboratories, so that the problem of preventing reperfusion injury and limiting infarct size in the setting of acute myocardial infarction remains largely unsolved. Heart Metab. 2008;40:20–22.
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