Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction.

Abstract

Primary percutaneous coronary intervention (PPCI) has dramatically changed the outcome of patients with ST-elevation myocardial infarction (STEMI). However, despite improvements in interventional technology, registry data show little recent change in the prognosis of patients who survive STEMI, with a significant incidence of cardiogenic shock, heart failure, and cardiac death. Despite a technically successful PPCI procedure, a variable proportion of patients experience suboptimal myocardial reperfusion. Large infarct size and coronary microvascular injury, as the consequence of ischaemia-reperfusion injury and distal embolization of atherothrombotic debris, account for suboptimal long-term prognosis of STEMI patients. In order to address this unmet therapeutic need, a broad-range of device-based treatments has been developed. These device-based therapies can be categorized according to the pathophysiological pathways they target: (i) techniques to prevent distal atherothrombotic embolization, (ii) techniques to prevent or mitigate ischaemia/reperfusion injury, and (iii) techniques to enhance coronary microvascular function/integrity. This review is an overview of these novel technologies with a focus on their pathophysiological background, procedural details, available evidence, and with a critical perspective about their potential future implementation in the clinical care of STEMI patients.

• Authors: Giovanni Luigi De Maria, Hector M Garcia-Garcia, Roberto Scarsini, Aloke Finn, Yu Sato, Renu Virmani, Ravinay Bhindi, Jonathan L Ciofani, Jorge Nuche, Henrique B Ribeiro, Wilson Mathias, Charan Yerasi, Tim A Fischell, Luuk Otterspoor, Flavio Ribichini, Borja Ibañez, Nico H J Pijls, Robert S Schwartz, Navin K Kapur, Gregg W Stone, Adrian P Banning
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 10 Issue 6 Pg. 687-697 (Aug 24 2021) ISSN: 2048-8734 [Electronic] England
• PMID: 33760016 (Publication Type: Journal Article, Review)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Topics

• Humans
• Myocardial Reperfusion
• Percutaneous Coronary Intervention
• ST Elevation Myocardial Infarction (surgery)
• Shock, Cardiogenic
• Treatment Outcome