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Cardiovascular Research Advance Access [Accepted Manuscript] published online on January 28, 2009
Cardiovascular Research, doi:10.1093/cvr/cvp032
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Benefits of reperfusion beyond infarct size limitation

Genzou Takemura, Munehiro Nakagawa, Hiromitsu Kanamori, Shinya Minatoguchi and Hisayoshi Fujiwara

From Division of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan

Address Correspondence to: Genzou Takemura, MD, PhD, Division of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan, Phone: ++81-58-230-6542, Fax: ++81-58-230-6524, E-mail: gt{at}gifu-u.ac.jp

The most critical determinant of prognosis in patients with acute myocardial infarction (MI) is infarct magnitude, which can be established within several hours of an attack. The importance of the subsequent healing process is not negligible, however. In fact, much experimental and clinical evidence suggests late reperfusion of the infarct-related coronary artery – i.e., at times too late to salvage myocardium within the area at risk – is beneficial for reducing left ventricular remodeling and decreasing mortality ("open artery hypothesis"). For instance, one recent study highlighted the beneficial effects of late reperfusion therapy on the infarct tissue cell dynamics following acute MI. Nonetheless, several recent large, randomized clinical trials have failed in provide evidence of such benefits, refuting the clinical efficacy of late reperfusion. In addition, they also underscore the need for revised clinical studies in which there is less heterogeneity in the timing of reperfusion and in the initial infarct size, as well as the need for sustained patency of the recanalized artery. This review focuses on the effects of late reperfusion on the pathophysiology of MI in context of the infarct tissue dynamics and clinical outcomes. We also discuss the issues that need to be resolved to improve clinical application.

KEYWORDS infarct tissue dynamics; late reperfusion; left ventricular remodeling; myocardial infarction; open artery hypothesis

Time for primary review: 28 Days


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