Primary Angioplasty: From the Artery to the Myocardium

Abstract

The prognosis of patients suffering from acute myocardial infarction (AMI) is related to the amount of muscle loss and ventricular function deterioration caused by the event. Primary angioplasty is the most effective reperfusion strategy. Early reperfusion limits the size of the infarction and improves the prognosis. However, the incidence of death and post-AMI heart failure remains around 20% during the first year. Factors that contribute to myocardial damage are ischemia, mechanical forces, inflammation, and reperfusion injury. All those take a variable and sometimes unpredictable preponderance at different times during the evolution of acute myocardial infarction. The damage caused by the different mechanisms is irreversible; therefore, any therapeutic strategy must be preventive. Developed treatments for continuous myocardial protection could potentially preserve the myocardium during the delay of the system and during the early evolution of the event. Developed controlled reperfusion procedures where the interventional cardiologist assumes the treatment not only of the culprit vessel but also of the myocardium could potentially decrease myocardial damage, preserve ventricular function, and improve patients’ prognosis.