Targeted pharmacotherapy for ischemia reperfusion injury in acute myocardial infarction

ABSTRACT

Introduction

Achieving reperfusion immediately after acute myocardial infarction improves outcomes; despite this, patients remain at a high risk for mortality and morbidity at least for the first year after the event. Ischemia–reperfusion injury (IRI) has a complex pathophysiology and plays an important role in myocardial tissue injury, repair, and remodeling.

Areas covered

In this review, the authors discuss the various mechanisms and their pharmacological agents currently available for reducing myocardial ischemia–reperfusion injury (IRI). They review important original investigations and trials in various clinical databases for treatments targeting IRI.

Expert opinion

Encouraging results observed in many preclinical studies failed to show similar success in attenuating myocardial IRI in large-scale clinical trials. Identification of critical risk factors for IRI and targeting them individually rather than one size fits all approach should be the major focus of future research. Various newer therapies like tocilizumab, anakinra, colchicine, revacept, and therapies targeting the reperfusion injury salvage kinase pathway, survivor activating factor enhancement, mitochondrial pathways, and angiopoietin-like peptide 4 hold promise for the future.

KEYWORDS:

• ST-segment elevation myocardial infraction
• myocardial injury
• ischemia reperfusion injury
• platelets
• oxidative stress
• tocilizumab
• anakinra
• colchicine
• revacept
• mitochondrial pathways

Article highlights

• Despite significant advancements in pharmacological and procedural interventions, MI is still associated with significant mortality and morbidity partially attributed to myocardial ischemia–reperfusion injury (IRI).

• The optimal treatment strategies to limit IRI remains elusive despite decades of research.

• The failure to translate benefits observed in experimental animal studies into the clinical setting may be related to a pathophysiology that involves many interdependent processes, treatment that should be administered before myocardial reperfusion and difficulty in overcoming the rapid and massive generation of reactive oxygen species following reperfusion.

• Identification of critical risk factors for IRI and targeting them individually rather than one size fits all approach should be the major focus of future research.

• Various newer therapies like tocilizumab, anakinra, colchicine, revacept, and therapies targeting the reperfusion injury salvage kinase pathway, survivor activating factor enhancement, mitochondrial pathways, and angiopoietin-like peptide 4 hold promise for the future.

This box summarizes the key points contained in the article.

Declaration of interest

PA Gurbel reports receiving grants from the National Institutes of Health, Bayer, Medicure, Instrumentation labs, USWorldMeds, Haemonetics, Amgen, Idorsia, Ionis, Janssen Pharmaceuticals, and Merck & Co; receiving honoraria and payment for lectures, consultations including service on speakers’ bureaus from Bayer, Janssen Pharmaceuticals, Merck & Co, UptoDate, and Medicure; and holding patents in the area of personalized antiplatelet therapy and interventional cardiology. U Tantry reports receiving honoraria from AstraZeneca, UptoDate, and Medicure. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.