Prevention of microvascular obstruction by addressing ischemia reperfusion injury-part B: Cardioprotective therapies

ST-segment elevation acute myocardial infarction (STEMI) is a major health problem. The implementation of reperfusion strategies has resulted in a very significant reduction of shortterm mortality. However, STEMI survivors with large infarctions are at high risk of chronic heart failure and associated comorbidities. The possibility of reducing infarct size might help alleviating the epidemics of heart failure. In many cases, despite optimal opening of the occluded epicardial coronary artery, tissue perfusion is inadequate due to microvascular obstruction (MVO). Given the central role of MVO in final infarct size, it is the target of different interventions. In the past decades, many strategies (pharmacological and mechanical) have been tested with the aim of reducing MVO and in turn lessen infarct size. Many interventions have failed in the translation from positive experimental studies into clinical trials, while some others have passed the initial checkpoint of pilot trials and are being tested in properly sized endpoints-oriented clinical trials. In this chapter we will describe the state of the art of the different strategies that are actively being tested in this field.