Limiting Infarct Size in ST-Segment Myocardial Infarction: The Holy Grail of Reperfusion Therapy.

A cute thrombotic occlusion of a coronary artery usually produces myocardial ischemia that can result in myocardial infarction if reperfusion is not restored. Reperfusion injury from reintroduction of blood and oxygen into the ischemic area at risk can result in additional myocyte cell death (1,2). Whereas early reperfusion therapy has been shown to reduce infarct size by decreasing ischemic injury time and results in lower morbidity and mortality rates (3), little progress has been made in decreasing the additional impact of reperfusion injury on infarct size despite 3 decades of effort (1,2,4). Although many interventions targeting reperfusion injury have seemed promising in experimental studies, they have failed to reduce infarct size consistently or improve clinical outcome in clinical trials and have not been endorsed by clinical practice guideline committees as effective therapeutic strategies (5). Nevertheless, reperfusion injury is a popular pre-clinical research area and the enthusiasts remain optimistic that a therapeutic breakthrough will eventually be achieved.