Reperfusion Strategies in Acute Myocardial Infarction: State of the Art

Abstract

ST elevation myocardial infarction (STEMI) is a highly prevalent condition worldwide. Reperfusion therapy is strongly associated with the prognosis of STEMI and must be performed with a high standard of quality and without delay. A systematic review of different reperfusion strategies for STEMI was conducted, including randomized controlled trials that included major cardiovascular events (MACE), and systematic reviews in the last 5 years through the PRISMA ( Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology. The research was done in the PubMed and Cochrane Central Register of Controlled Trials databases, in addition to a few manual searches. After the exclusion criteria were applied, 90 articles were selected for this review. Despite the reestablishment of IRA patency in PCI for STEMI, microvascular lesions occur in a significant proportion of these patients, which can compromise ventricular function and clinical course. Several therapeutic strategies – intracoronary administration of nicorandil, nitrates, melatonin, antioxidant drugs (quercetin, glutathione), anti-inflammatory substances (tocilizumab [an inhibitor of interleukin 6], inclacumab, P-selectin inhibitor), immunosuppressants (cyclosporine), erythropoietin and ischemic pre- and post-conditioning and stem cell therapy – have been tested to reduce reperfusion injury, ventricular remodeling and serious cardiovascular events, with heterogeneous results: These therapies need confirmation in larger studies to be implemented in clinical practice

Acute Myocardial Infarction/therapy; Myocardial Reperfusion; Myocardial Stunning; Ventricular Remodeling; Morbidity and Mortality

Prevalence

The worldwide prevalence of ischemic heart disease is approximately 111 million cases, with 7.3 million cases of fatal acute myocardial infarction (AMI) in 2015. The inadequate treatment of patients with AMI is associated with significant increases in morbidity and mortality.¹

Objectives

The objective of this systematic review is to evaluate the evidence of different reperfusion therapies in ST-segment elevation AMI (STEMI), selecting mainly randomized controlled trials and systematic reviews that address major cardiovascular clinical outcomes.

Methods

The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched the PubMed database for the terms “acute myocardial infarction” and “reperfusion therapy”, which yielded 9,885 results. After applying the following search filters – type of abstract: “text and full text”; type of article: “meta-analysis, review, systematic review and randomized clinical trial”, and date of publication: “last 5 years”, and language: “English” – 127 articles were obtained. In addition, research was conducted at the Cochrane Central Register of Controlled Trials using the terms “acute myocardial infarction” and “reperfusion therapy”, in English, between 2018 and 2020, which revealed 64 clinical trials, already excluding duplicates. Of the 191 articles, nine articles were selected manually and added to the review, as they were considered of high relevance to the topic. Of the 200 articles, 92 were removed after analysis of the abstracts and, after reading the full texts, 18 (12 in PubMed and 6 in the Cochrane database) of the 108 remaining were excluded for not addressing reperfusion, yielding a total of 90 references, which were included in this review.

Results

Revascularization Strategies

The invasive strategy is the treatment of choice for reperfusion of patients with high-risk non-ST elevation AMI (STEMI).¹ , ² Delays in reperfusion therapy for patients with STEMI cause significant impairments in myocardial reperfusion.³

Patients with acute coronary syndrome (ACS), who had transient ST elevation, were analyzed before reperfusion, and no differences were found in the size of the infarction or in the rates of serious ischemic events.⁴

Hospital interventions for qualitative improvement in the care of patients with STEMI can improve myocardial reperfusion.⁵ Difficulties in implementing reperfusion therapy include: delay in seeking care, absence of adequate pre-hospital emergency systems, absence of trained emergency services, inadequate hospital structure, absence of quality improvement and rehabilitation programs.⁶

Thrombolytics

Thrombolytics are indicated for patients with STEMI in the first 12 hours of symptom onset, in cases where percutaneous coronary intervention (PCI)-related delay would be 120 minutes or more. Thrombolytics can be administered in the first 30 minutes of first medical contact, with no contraindications. Streptokinase is associated with higher mortality rates and lower reperfusion rates as compared with tissue plasminogen activator (tPA) and its recombinant forms – alteplase, tenecteplase (TNK) and reteplase. Therefore, a fibrin-specific agent should be chosen, since, although the administration of TNK in a single bolus is equivalent to accelerated tPA, in terms of reducing mortality in 30 days, it is safer in reducing non-cerebral hemorrhages and preventing blood transfusions, with easier administration.¹ , ³

Percutaneous Coronary Intervention (PCI) x Thrombolysis

In STEMI without previous fibrinolytic therapy, PCI is the best strategy for reperfusion of AMI when performed by experienced operators, ideally within the first 90 minutes of admission. Although thrombolysis allows early vascular reperfusion, with an average rate of infarct-related artery (IRA) patency of 50%, in PCI the rates are greater than 90%, with a reduction in the incidence of reinfarction.⁷

Pharmacoinvasive Therapy

When a delay to primary PCI is suspected, fibrinolytic therapy should be immediately followed by the transfer, between 2 hours and 24 hours, to a coronary intervention center, for coronary angiography and PCI of the IRA, a strategy called “pharmacoinvasive therapy”, or for rescue angioplasty if there are no signs of reperfusion.¹ , ² Although a superiority of the pharmacoinvasive strategy over thrombolysis with Tenecteplase has been shown, no differences were found after 8 years regarding major cardiovascular events (MACE).⁸ Compared with primary PCI, the pharmacoinvasive strategy showed no differences in the occurrence of MACE in 30 days.⁹ , ¹⁰ The pharmacoinvasive strategy using streptokinase reduced the size of the infarction and MACE, compared to conventional thrombolysis.¹¹ The effectiveness of the pharmacoinvasive strategy does not depend on initial troponin levels,¹² and the radial access was considered safe and effective in the pharmacoinvasive strategy.¹³

The EARLY-MYO Study demonstrated that in patients with STEMI presenting less than 6 h after symptom onset and expected delay to PCI, the pharmacoinvasive strategy with half-dose of alteplase was not inferior to PCI in complete epicardial and myocardial reperfusion evaluated defined as thrombolysis in myocardial infarction (TIMI) grade 3, TIMI perfusion grade 3 and resolution of the ST segment ≥70% in 60 minutes.¹⁴ In patients who admitted within 6 hours of STEMI and underwent PCI, intracoronary administration of low doses of alteplase had no effect on the degree of microvascular obstruction or on clinical outcomes.¹⁵

Electrocardiogram on Reperfusion

The reduction in QRS duration immediately after and 60 minutes after reperfusion was associated with its success, but the presence of QRS fragmentation had an inverse correlation.¹⁶ Incomplete resolution of ST-segment depression (reciprocal image of ST elevation) 90 minutes after PCI was correlated with larger infarctions and MACE.¹⁷ The absence of ST resolution was poor prognostic factor after primary PCI, but complete resolution of the ST elevation was associated with an increased risk of ST elevation at the time of discharge.¹⁸ The complete resolution (≥ 70%) of the ST elevation, 60 minutes after PCI, was associated with greater reduction of MACE; however, the presence of diabetes mellitus and delay in reaching the hospital were deleterious to reperfusion.¹⁹ Distortion of the terminal portion of the QRS was associated with cardiac dysfunction.²⁰ The presence of Q wave on the initial ECG was associated with mortality, regardless of the time interval to peripheral PCI.²¹ Early HR elevation ≥ 100 bpm was an independent prognostic marker.²² Reperfusion arrhythmias, defined by accelerated idioventricular rhythm and ventricular extrasystoles with long periods of coupling, are well tolerated and may be related to the infarction size and reperfusion injury.²³ The peak of plasma troponin T occurs after 12 hours of type 1 AMI and after 6 hours of AMI successfully reperfused, with a second peak after 24 hours.²⁴

Figure 1
– Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram

Coronary flow (TIMI flow grades 0 or 1) before PCI is an independent risk factor for microcirculatory obstruction and size of AMI.²⁵

Thrombectomy in PCI

Embolization of thrombus fragments in PCI can lead to microcirculatory obstruction, with impacts on myocardial remodeling and prognosis.²⁶ In patients with a high thrombotic load in the IRA undergoing PCI, there was an improvement in coronary flow after the intervention with aspiration catheter, but without differences in the VCTs .²⁶ There were no differences regarding the effectiveness of coronary reperfusion between manual and mechanical methods²⁷ . The procedure should be reserved for patients with high thrombotic burden, and its routine use is not recommended, since it did not reduce MACE and increased the risk of stroke.¹

Stents at Primary PCI

There was a reduction in the target vessel revascularization rate, in favor of drug-eluting stents in relation to conventional stents in PCI, in addition to MACE reduction,²⁷ leading to the recommendation of eluted stent implantation as a preferred strategy.²⁸ The option of late stent implantation in PCI, with the objective of reducing microvascular obstruction, had no effect in reducing MACE, but increased the rate of revascularization of the target vessel.²⁹

Antiplatelet Therapy

The loading dose of acetyl salicylic acid (162 mg to 325 mg) should be administered shortly after the diagnosis of AMI, followed by low maintenance doses (75-100 mg) indefinitely, as they are equally effective as larger doses for MACE reduction, but causing less bleeding.¹

P2Y12 Inhibitors

Clopidogrel is an irreversible inhibitor of the adenosine diphosphate (ADP) platelet receptor P2Y12, being recommended in acute coronary syndromes (ACSs), regardless of the performance of primary PCI. The addition of clopidogrel reduces the risk of CVMS in patients with SCASST , treated or not with PCI.³⁰ , ³¹ In patients with STEMI treated with thrombolysis, clopidogrel also significantly reduces MACE, without increasing hemorrhagic outcomes.³² , ³³ A loading dose of clopidogrel (300 mg) is recommended in patients <75 years of age, after fibrinolysis.³⁴

Clopidogrel requires conversion of hepatic cytochromes to the active form. The activity of the C19 allele has great variation in the population, increasing the risks of thrombotic events. Clopidogrel has a relatively small antiplatelet potency and a slow onset of action, which is a disadvantage, especially in patients treated with PCI, who have considerable thrombotic burden. The onset of action of ticagrelor and prasugrel is, respectively, 30 minutes and 60 minutes.⁷ Prasugrel was shown to be superior to clopidogrel in patients with ACS undergoing PCI, with reductions in the rates of death from cardiovascular causes, infarction, stroke, and a 52% relative reduction for stent thrombosis. However, rates of major bleeding and life-threating bleeding were greater in patients receiving prasugrel compared with clopidrogrel. There were no benefits in patients with cerebrovascular disease, individuals older than 75 years or those with a body weight less than 60Kg.³⁵ Ticagrelor, a direct-acting and reversible P2Y12 inhibitor, with a shorter duration of action, was superior to clopidogrel in ACS, both in invasive and conservative strategies, with a decrease in MACE and mortality (by 22%) rates, but higher rate of major bleeding not related to CABG. Although not significantly, there was a higher incidence of sinus pauses and dyspnea in patients taking ticagrelor than in those taking clopidogrel.³⁶ Another study obtained favorable results for ticagrelor administered before PCI.³⁷

Morphine prolongs gastric emptying and delays the onset of action of prasugrel, ticagrelor and clopidogrel.⁷ In the absence of contraindications, ticagrelor and prasugrel are recommended, preferably, in ACSs.¹ , ² , ³⁸

There were no differences in reperfusion rates before PCI when ticagrelor was initiated in the ambulance (prehospital treatment) than in the catheterization laboratory; but prehospital treatment reduced rates of stent thrombosis and MACE.³⁹ Diabetics had lower rates of reperfusion and a higher incidence of MACE, with a large increase in stent thrombosis.⁴⁰ The comparative analysis of the administration of clopidogrel, prasugrel or ticagrelor in the emergency room in patients treated with PCI, showed a superiority of prasugrel and ticagrelor over clopidogrel, regarding reperfusion rates pre- and post-PCI.⁴¹ In STEMI, the administration of intravenous agents that are extremely fast and potent, such as cangrelor, may be advantageous for patients who have not received P2Y12, patients with hemorrhagic complications or for whom surgery is indicated.⁷ , ³⁸ In patients with STEMI, when compared with ticagrelor, cangrelor produced greater inhibition of P2Y12 receptors, but there were no differences regarding coronary microvascular function and infarct size.⁴² , ⁴³ The TREAT study compared clopidogrel with ticagrelor after fibrinolytic therapy, with no differences in the incidence of VCT or severe bleeding after one year, which suggests the use of ticagrelor 24 hours after STEMI, initially treated with chemical thrombolysis.⁴⁴

GPIIbIIa (IGP) Inhibitors

PGIs (abcxicimab, tirofiban and eptifibatide) are potent and fast inhibitors. There is no evidence of the benefits of the administration of PGI with contemporary dual oral antiplatelet therapy in patients with ACS; however, as it can increase the bleeding risk, PGIs are recommended in situations where there is a significant thrombotic burden in PCI.⁷ , ³⁷ The inability to reperfuse a myocardial region, despite the opening of the IRA, is an independent prognostic factor, whose mechanisms are microembolization, reperfusion injury, endothelial dysfunction, myocardial edema, microcirculation vasospasm, and neutrophil aggregates.⁴⁵ Selective injection of tirofiban through a catheter showed improvement in reperfusion in patients with STEMI and high thrombotic load, but without differences in VCT.⁴⁶ The intracoronary (ic) injection of tirofiban was superior to intravenous administration regarding reperfusion parameters, left ventricular ejection fraction (LVEF), but with no differences in VCT or hemorrhagic outcomes.⁴⁷ Another study compared intralesional versus intracoronary administrations of PGI in patients with ACS and demonstrated a superiority of the first strategy.⁴⁵ The COCKTAIL II trial⁴⁸ also showed advantages of the intralesional administration of abciximab over intracoronary injection, in terms of better reperfusion.⁴⁸

Statins and Reperfusion

A meta-analysis of treatment with high-dose statins before PCI revealed improvement in reperfusion and a 47% reduction in MACE with atorvastatin in ACS patients, who had not received statins previously. No benefits were found with rosuvastatin.⁴⁹ A study showed that the administration of 80 mg of atorvastatin before PCI reduced the incidence of no-reflow and MACE, and increased survival.⁵⁰

Reperfusion Injury

Despite the restoration of the IRA patency in PPCI, microvascular lesions occur in a large proportion of these patients, which can compromise ventricular function and clinical outcome. The REDUCE-MVI trial showed no differences in microcirculatory resistance rates in patients undergoing PCI and treated with ticagrelor or prasugrel, resulting in similar infarction sizes.⁵¹

The ic administration of adenosine or sodium nitroprusside in patients with STEMI did not reduce the size of the infarction or the degree of microvascular obstruction.⁵² The ic infusion of insulin-like growth factor after primary PCI improved ventricular remodeling.⁵³ Several trials have shown that both intravenous and ic administration of nicorandil in primary PCI improved reperfusion, left ventricular function and MACE⁵⁴ - ⁵⁷ rates.

A meta-analysis of experimental studies demonstrated benefit with treatment with nitric oxide in reducing reperfusion injury and size of AMI.⁵⁸ The ic administration of nitrate reduced systemic inflammatory activity.⁵⁹ There was a reduction in the incidence of ventricular tachycardia with the use of ic nitrite in patients undergoing PCI.⁶⁰

Liraglutide administered 30 minutes before PCI reduced the no-reflow rates and decreased the concentration of C-reactive protein, however, there was no difference in the incidence of ECVM.⁶¹

Intravenous or ic administration of melatonin was not associated with a reduction in the size of AMI and increased left ventricular remodeling;⁶² however, when administration was early, it reduced the size of the infarction.⁶³

The ic injection of morphine did not reduce the size of the AMI in patients undergoing PCI PCI⁶⁴ . There was no reduction in the size of AMI in patients treated with a mineralocorticoid receptor antagonist before reperfusion, but there was an improvement in left ventricular remodeling.⁶⁵

There was no reduction in MACE with the administration of intravenous erythropoietin after reperfusion.⁶⁶ In addition, the ic injection of erythropoietin, before reperfusion, did not reduce the size of the AMI or the left ventricular remodeling.⁶⁷

In patients undergoing PCI, intravenous injection of cyclosporine did not reduce MACE or left ventricular remodeling.⁶⁸ Other trials have also failed to demonstrate a favorable impact of intravenous cyclosporine administered prior to PCI.⁶⁹ - ⁷¹

The intravenous infusion Quercetin (antioxidant) during reperfusion of ARI improved the clinical course of the disease, accelerating the onset of reperfusion⁷²

An experimental study showed attenuation of reperfusion myocardial injury with artesunate administration (an antimalarial substance).⁷³

The infusion of Glutathione (antioxidant), before PCI, showed a reduction in the production of hydrogen peroxide and an increase in nitric oxide, which may improve cardiomyocyte survival.⁷⁴

It was found that the monoclonal antibody against P-Selectin (Inclacumab), administered before PCI, reduced the size of the infarction. The ic administration of anisodamine improved reperfusion and reduced MACE.⁷⁵

Also, interleukin-6 (IL-6) can participate in reperfusion injury. The IL-6 receptor antagonist, tocilizumab, was tested in STEMI, before coronary angiography, with a reduction in the systemic inflammatory response and troponin release.⁷⁶

Stem Cells

The administration of granulocyte-colony stimulating factor (G-CSF) did not influence the size of the AMI, left ventricular function or ECV in patients with AMI that underwent PCI.⁷⁷

The ic infusion of autologous bone marrow stem cells (ABMC) 24 hours after PCI did not increase LVEF, but increased the rate of myocardial salvage.⁷⁸ The ic injection of primitive stromal cells after reperfusion increased the viability in the AMI territory and LVEF.⁷⁹ The TECAM trial ⁸⁰ analyzed the ic injection of ABMC or subcutaneous G-CSF in the STEMI and showed no differences in left ventricular function.

A meta-analysis on ABMC to treat AMI showed that the ic infusion of ABMC led to an increase in LVEF and reduction of ventricular remodeling in up to 12 months, and was considered a safe and effective treatment in patients with AMI.⁸¹

In addition, a laser therapy applied to the tibia bone before and 24 and 72 hours after PCI reduced the troponin-T levels, with few adverse effects, but no differences were found in LVEF.⁸²

Ischemic Postconditioning

Ischemic postconditioning was assessed for recanalization of the IRA, through four repetitions of balloon occlusion, with no reductions in mortality and hospitalization rates for heart failure.⁸³ Another study on remote ischemic postconditioning in the upper limb, after PCI, demonstrated a reduction in the plasma release of CK-MB and an increase in LVEF and glomerular filtration rate.⁸⁴ Another study on ischemic postconditioning showed improvement in reperfusion and size of AMI.⁸⁵ Remote ischemic preconditioning uses brief cycles of cuff insufflation and deflation to protect the myocardium from reperfusion injury. A meta-analysis showed favorable results for this strategy, including higher myocardial salvage rate, reduced infarct size and reduced MACE.⁸⁶ The increase in plasma concentrations of the soluble tumor necrosis factor (TNF)-related apoptosis-inducing ligand (sTRAIL) after reperfusion was related to a reduction in the size of AMI and improvement in LVEF.⁸⁷ There were reductions in the size of AMI and reperfusion injury with ischemic postconditioning, in patients admitted for less than four hours.⁸⁸ A trial on remote ischemic preconditioning did not show changes in the rates of death and heart failure at 12 months of follow-up.⁸⁹

Multivessel Coronary Artery Disease

The AIDA STEMI trial analyzed patients with STEMI and multivessel coronary artery disease and found a higher prevalence of diabetes and advanced age when compared to patients with single-vessel disease. There were no differences in the reperfusion rates between the two groups, but those with multivessel disease had higher MACE rates over a year.⁹⁰

Conclusions

An effective reperfusion of STEMI, in a timely manner, defines the prognosis. Patients should be selected for primary angioplasty or thrombolysis, followed by PCI in 24 hours (pharmacoinvasive therapy). Fibrin-specific agents are superior to streptokinase. Anticoagulant and dual antiplatelet therapy have evolved substantially in recent years, with a reduction in severe ischemic outcomes, such as death, reinfarction and stroke. The time factor and the experience of the interventionists are paramount in decision making for primary PCI. PCI has advanced in recent years, notably with the development of state-of-the-art drug-eluting stents. Even with an adequate opening of the IRA in PCI, there may be a failure in coronary microcirculatory reperfusion. Several clinical trials have tested different substances and different strategies, with inconclusive results regarding the improvement of tissue reperfusion, preservation of ventricular function and reduction of serious ischemic outcomes. Larger randomized controlled studies will be needed to test these therapeutic possibilities.

References

• ¹
  Reed RW, Rossi JE, Cannon CP. Acute Myocardial Infarction, Seminar. Lancet 2017;389(10065):197-210.
• ²
  Neumann FJ, Uva MS, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al.2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165.
• ³
  Prasad A, Gersh BJ, Mehran R, Brodie BR, Brener SJ, Dizon JM, et al. Effect of Ischemia Duration and Door-to-Balloon Time on Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction: An Analysis From HORIZONS-AMI Trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction). JACC Cardiovasc Interv. 2015; 8(15):1966-74.
• ⁴
  Lemkes JS, Janssens GN, van der Hoeven NW, van de Ven PM, Marques KM, Nap A, et al. Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial. Eur Heart J. 2019;40(3):283-91.
• ⁵
  Bahiru E, Agarwal A, Berendsen MA, Baldridge AS, Temu T, Rogers A, et al. Hospital-Based Quality Improvement Interventions for Patients With Acute Coronary Syndrome: A Systematic Review. Circ Cardiovasc Qual Outcomes. 2019;12(9):e005513.
• ⁶
  Nascimento BR, Brant LC, Marino BCA, Passaglia LG, Ribeiro AL. Implementing myocardial infarction systems of care in low/middle-income countries l. Heart. 2019;105(1):20-6.
• ⁷
  Khan N, Cox AR, Cotton JM. Pharmacokinetics and pharmacodynamics of oral P2Y12 inhibitors during the acute phase of a myocardial infarction: A systematic review. Thromb Res.2016 Jul; 143:141-8.
• ⁸
  Arbel Y, Ko DT, Yan AT, Cantor WJ, Bagai A, Koh M, et al. TRANSFER-AMI Trial Investigators. Long-term Follow-up of the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI). Can J Cardiol. 2018;34(6):736-43.
• ⁹
  Welsh RC, Goldstein P, Sinnaeve P, Ostojic MC, Zheng Y, Danays T, et al. Relationship between community hospital versus pre-hospital location of randomisation and clinical outcomes in ST-elevation myocardial infarction patients: insights from the Stream study. Eur Heart J Acute Cardiovasc Care. 2018;(6):504-13.
• ¹⁰
  Bendary A, Tawfek W, Mahros M, Salem M. Primary PCI versus pharmaco-invasive strategy in patients with ST-Elevation myocardial infarction; A randomized clinical study. J Cardiovas Dis Res 2018;9(1):28‐31.
• ¹¹
  Helal AM, Shaheen SM, Elhammady WA, Ahmed MI, Abdel-Hakim AS, Allam LE. Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction. Int J Cardiol Heart Vasc. 2018;21:87‐93.
• ¹²
  Tan NS, Goodman SG, Cantor WJ, Russo JJ, Borgundvaag B, Fitchett D, et al. Efficacy of Early Invasive Management After Fibrinolysis for ST-Segment Elevation Myocardial Infarction in Relation to Initial Troponin Status. Can J Cardiol.2016;32(10):1221.e11-1221.e18.
• ¹³
  Sultan E-ZM, Rabea HM, Abdelmeguid KR, Mahmoud HB. Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach. Egypt Heart J. 2018;70(1):1‐7.
• ¹⁴
  u J, Ding S, Ge H, Han Y, Guo J, Lin R, et al. EARLY-MYO Investigators. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction. Circulation. 2017 17;136(16):1462-73.
• ¹⁵
  McCartney PJ, Eteiba H, Maznyczka AM, McEntegart M, Greenwood JP, Muir DF, et al. T-TIME Group. Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients With Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA. 2019.1;321(1):56-68.
• ¹⁶
  Pranata R, Yonas E, Chintya V, Alkatiri AA. Fragmented QRS and QRS Duration As a Marker of Myocardial Reperfusion Measured by Myocardial Blush Grade in Reperfusion Therapy: Systematic Review and Meta-Analysis. Int J Angiol. 2019;28(4):255-61.
• ¹⁷
  Reinstadler SJ, Baum A, Rommel KP, Eitel C, Desch S, Mende M, et al. ST-segment depression resolution predicts infarct size and reperfusion injury in ST-elevation myocardial infarction. Heart. 2015;101(22):1819-25.
• ¹⁸
  Cuenin L, Lamoureux S, Schaaf M, Bochaton T, Monassier JP, Claeys MJ, et al. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year. Circ J. 2018;82(5):1379-86.
• ¹⁹
  Fabris E, van 't Hof A, Hamm CW, Lapostolle F, Lassen JF, Goodman SG, et al. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial. Eur Heart J Acute Cardiovasc Care. 2019;8(3):208-17.
• ²⁰
  Valle-Caballero MJ, Fernández-Jiménez R, Díaz-Munoz R, Mateos A, Rodríguez- Álvarez M, Iglesias-Vázquez JA et al. QRS distortion in pre-reperfusion electrocardiogram is a bedside predictor of large myocardium at risk and infarct size (a METOCARD-CNIC trial substudy). Int J Cardiol.2016;202(1): 666-73.
• ²¹
  Kosmidou I, Redfors B, Crowley A, Gersh B, Chen S, Dizon JM, et al. Prognostic implications of Q waves at presentation in patients with ST-segment elevation myocardial infarction undergoing primary percutaneouscoronary intervention: An analysis of the HORIZONS-AMI study. Clin Cardiol. 2017;(11):982-7.
• ²²
  Nepper-Christensen L, Lønborg J, Ahtarovski KA, Høfsten DE,Kyhl K, Schoos, MM, et al. Importance of elevated heart rate in the very early phase of ST-Segment elevation myocardial infarction: Results from the DANAMI-3 trial. Eur Heart J Acute Cardiovasc Care. 2019;8(4):318-28.
• ²³
  Van der Weg K, Kuijt WJ, Tijssen JG, Bekkers SC, Haeck JD, Green CL, et al. Prospective evaluation of where reperfusion ventricular arrhythmia "bursts" fit into optimal reperfusion in STEMI. Int J Cardiol. 2015;195:136-42.
• ²⁴
  Daaboul Y, Korjian S, Weaver WD, Kloner RA, Giugliano RP, Carr J, et al. Myocardial Infarction (from the EMBRACE STEMI Clinical Trial). Am J Cardiol. 2016;118(5):625-31. Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial). Am J Cardiol. 2016;118(5):625-31.
• ²⁵
  Joost A, Stiermaier T, Eitel C, Fuernau G, de Waha S, Desch S, et al. Impact of Initial Culprit Vessel Flow on Infarct Size,Microvascular Obstruction, and Myocardial Salvage in Acute Reperfused ST-Elevation Myocardial Infarction. Am J Cardiol. 2016;118(9):1316-22.
• ²⁶
  Li P, Ruan JW, Liu M, Li SY, Wang ZD, Xie WC. Thrombus aspiration cateter improve the myocardial reperfusion of STEMI patients with high thrombus load during the emergency PCI operation. J Cardiothorac Surg. 2019;14(1):172.
• ²⁷
  Giglioli C, Cecchi E, Sciagrá R, Baldereschi GJ, Meucci F, Valente S, et al. COmparison between COronary THrombus aspiration with Angiojet® or Export® catheter in patients with ST-elevation myocardial infarction submitted to primary angioplasty: The COCOTH Study. Int J Cardiol. 2016; 203:757-62.
• ²⁸
  De Luca G, Stone GW, Suryapranata H, Laarman GJ, Menichelli M, Kaiser C, et al. Efficacy and safety of drug-eluting stents in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. Int J Cardiol. 2009; 133(2):213–22.
• ²⁹
  Kelbaek H, Hofsten DE, Kober L, Helqvist S, Klovgaard L, Holmvang L, et al. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): An open-label, rando- mised controlled trial. Lancet .2016;387(10034):2199–206.
• ³⁰
  Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, the Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001; 345(7):494-502.
• ³¹
  Mehta SR, Yusuf S, Peters RJG, Bertrand ME, Lewis BS, Natarajan MK, et al. for the Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators*. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358(9281):527-33.
• ³²
  Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, et al, and the COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366(9497):1607-21.
• ³³
  Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al, and the CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352(12):1179-89.
• ³⁴
  Mehta SR, Bassand JP, Chrolavicius S, Diaz R, Eikelboom JW, Fox KA, et al, and the CURRENT- OASIS 7 Investigators. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010;363(10):930-42.
• ³⁵
  Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001-15.
• ³⁶
  Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045-57.
• ³⁷
  Zhang J, Ding Y, Li X, Luo Y, Zhang J. Efficacy of dual anti-platelet therapy with ticagrelor and aspirin in the treatment of acute myocardial infarction patients undergoing percutaneous coronary intervention. Pharmac Care Res. 2019;19(4):259-62.
• ³⁸
  Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2018 ;39(2):119–77.
• ³⁹
  Cayla G, Lapostolle F, Ecollan P, Stibbe O, Benezet JF, Henry, et al. ACTION study group. Pre-hospital ticagrelor in ST-segment elevation Myocardial infarction in the French ATLANTIC population. Int J Cardiol. 2017;244:49-53.
• ⁴⁰
  Fabris E, van't Hof AA, Hamm CW, Lapostolle F. Lassen JF, Goodman SG, et al. Pre-hospital administration of ticagrelor in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: a sub-analysis of the ATLANTIC trial Catheterization and cardiovascular interventions. 2019;93(7): E369‐E377.
• ⁴¹
  Mont'Alverne-Filho JR, Rodrigues-Sobrinho CR, Medeiros F, Falcão FC, Falcão JL, Silva RC, et al. Upstream clopidogrel, prasugrel, or ticagrelor for patients treated with primary angioplasty: Results of an angiographic randomized pilot study. Catheter Cardiovasc Interv. 2016;87(7):1187-93.
• ⁴²
  Khan N, Amoah V, Cornes M, Martins J, Wrigley B, Khogali S, et al. Marked differences in the pharmacokinetic and pharmacodynamic profiles of ticagrelor in patients undergoing treatment for st elevation and non st elevation myocardial infarction (STEMI and NSTEMI) Heart. 2018;104:A9-A10.
• ⁴³
  Ubaid S, Ford TJ, Berry C, Murray HM, Wrigley B, Khan N, et al. Cangrelor versus Ticagrelor in Patients Treated with Primary Percutaneous Coronary Intervention: Impact on Platelet Activity,Myocardial Microvascular Function and Infarct Size: A Randomized Controlled Trial. Thromb Haemost. 2019;119(7):1171-81.
• ⁴⁴
  Berwanger O, Lopes RD, Moia DD, Fonseca FA, Jiang L, Goodman SG, et al. Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis TREAT Trial. J Am Coll Cardiol. 2019;73(22):2819-28.
• ⁴⁵
  Sun B, Liu Z, Yin H, Wang T, Chen T, Yang S, et al. Intralesional versus intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndromes: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Oct;96(40):e8223.
• ⁴⁶
  Zhang Z, Li W, Wu W, Xie Q, Li J, Zhang W, et al. Myocardial reperfusion with tirofiban injection via aspiration catheter: efficacy and safety in STEMI patients with large thrombus burden. Herz. 2020 May;45(3):280-7.
• ⁴⁷
  Esfandi A, Fotouhi M, Allami A, Ebrahimi M. Comparison between the Outcomes of Intracoronary and Intravenous Administration of Eptifibatide during Primary Percutaneous Coronary Intervention in Patients with Acute ST-Elevation Myocardial Infarction. J Atheroscler Thromb.2016;23(4):465-76.
• ⁴⁸
  Prati F, Romagnoli E, Limbruno U, Pawlowski T, Fedele S, Gatto L, et al.Randomized evaluation of intralesion versus intracoronary abciximab and aspiration thrombectomy in patients with ST-elevation myocardial infarction: The COCTAIL II trial. Am Heart J. 2015;170(6):1116-23.
• ⁴⁹
  Xiao Y, He S, Zhang Z, Feng H, Cui S, Wu J. Effect of High-Dose Statin Pretreatment for Myocardial Perfusion in Patients Receiving Percutaneous Coronary Intervention (PCI): A Meta-Analysis of 15 Randomized Studies. Monit.2018 17;24:9166-76.
• ⁵⁰
  García-Méndez RC, Almeida-Gutierrez E, Serrano-Cuevas L, Sanchez-Díaz JS, Rosas-Peralta M, Ortega-Ramirez JA et al. Reduction of No Reflow with a Loading Dose of Atorvastatin before Primary Angioplasty in Patients with Acute ST Myocardial Infarction. Arch Med Res. 2018;49(8):620-9.
• ⁵¹
  van Leeuwen MAH, van der Hoeven NW, Janssens GN, Everaars H, Nap A, Lemkes JS, et al. Evaluation of Microvascular Injury in Revascularized Patients With ST-Segment-Elevation Myocardial Infarction Treated With Ticagrelor Versus Prasugrel. Circulation. 2019 Jan 29;139(5):636-646.
• ⁵²
  Nazir SA, McCann GP, Greenwood JP, Kunadian V, Khan JN, Mahmoud, et al. Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local adjunctive therapy in ST-elevation myocardial infarction trial. Eur Heart J. 2016;21;37(24):1910-1919.
• ⁵³
  Caplice NM, DeVoe MC, Choi J, Dahly D, Murphy T, Spitzer E, et al. Randomized placebo controlled trial evaluating the safety and efficacy of single low-dose intracoronary insulin-like growth factor following percutaneous coronary intervention in acute myocardial infarction (RESUS-AMI). Am Heart J.2018.200:110-7.
• ⁵⁴
  Xu L, Wang L, Li K, Zhang Z, Sun H, Yang X. Nicorandil prior to Primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2019.29;13:1389-400.
• ⁵⁵
  Yu L, Huang B, Po SS, Tan T, Wang M, Zhou L, et al. Low-Level Tragus Stimulation for the Treatment of Ischemia and Reperfusion Injury in Patients With ST-Segment Elevation Myocardial Infarction: A Proof-of-Concept Study. JACC Cardiovasc Interv. 2017; 10(15):1511-20.
• ⁵⁶
  eng C, Liu Y, Wang L, Niu D, Han B. Effects of Early Intracoronary Administration of Nicorandil During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction. Heart Lung Circ. 2019. Jun;28(6):858-65.
• ⁵⁷
  Ji Z, Zhang R, Lu W, Ma G, Qu Y. The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir J Med Sci. 2020;189(1):119-31.
• ⁵⁸
  Bice JS, Jones BR, Chamberlain GR, Baxter GF. Nitric oxide treatments as adjuncts to reperfusion in acute myocardial infarction: a systematic review of experimental and clinical studies. Basic Res Cardiol. 2016;111(2):23.
• ⁵⁹
  Jones DA, Khambata RS, Andiapen M, Rathod KS, Mathur A, Ahluwalia A.Intracoronary nitrite suppresses the inflammatory response following Primary percutaneous coronary intervention. Heart. 2017;103(7):508-16.
• ⁶⁰
  Jones DA, Rathod KS, Williamson A, Harrington D, Andiapen M, van Eijl S, et al.The effect of intracoronary sodium nitrite on the burden of ventricular arrhythmias following primary percutaneous coronary intervention for acute myocardial infarction. Int J Cardiol. 2018;266:1-6.
• ⁶¹
  Chen WR, Tian F, Chen YD, Wang J, Yang JJ, Wang ZF, et al. Effects of liraglutide on no-reflow in patients wit acute ST-segment elevation myocardial infarction. Int J Cardiol. 2016;208:109-14.
• ⁶²
  Gonzalez-Gonzalez J, Garcia-Camarero T, Consuegra Sanchez L,Piccolo R, J Gonzalez-Gonzalez et al MARIA Investigators. Effect of intravenous and intracoronary melatonin as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: Results of the Melatonin Adjunct in the acute myocaRdial Infarction treated with Angioplasty trial. J Pineal Res.2017;62(1):e12374.
• ⁶³
  Dominguez-Rodriguez A, Abreu-Gonzalez P, de la Torre-Hernandez JM, Consuegra-Sanchez L, Piccolo R, Gonzalez-Gonzalez J,et al; MARIA Investigators.Usefulness of Early Treatment With Melatonin to Reduce Infarct Size in Patients With ST-Segment Elevation Myocardial Infarction Receiving Percutaneous Coronary Intervention (From the Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty Trial). Am J Cardiol. 2017;120(4):522-6.
• ⁶⁴
  Le Corvoisier P, Gallet R, Lesault PF, Audureau E, Paul M, Ternacle J, et al. Intra-coronary morphine versus placebo in the treatment of acute ST-segment elevation myocardial infarction: the MIAMI randomized controlled trial. BMC Cardiovasc Disord. 2018;18(1):193.
• ⁶⁵
  Bulluck H, Fröhlich GM, Nicholas JM, Mohdnazri S, Gamma R, Davies J, et al. Mineralocorticoid receptor antagonist pre-treatment and early post-treatment to minimize reperfusion injury after ST-elevation myocardial infarction: The MINIMIZE STEMI trial. Am Heart J. 2019;211:60-7.
• ⁶⁶
  Steppich B, Groha P, Ibrahim T, Schunkert H, Laugwitz KL, Hadamitzky M, et al. Regeneration of Vital Myocardium in ST-Segment Elevation Myocardial Infarction by Erythropoietin (REVIVAL-3 Study Investigators. Effect of Erythropoietin in patients with acute myocardial infarction:five-year results of the REVIVAL-3 trial. BMC Cardiovasc Disord. 2017;17(1):38.
• ⁶⁷
  Seo WW, Suh JW, Oh IY, Yoon CH, Cho YS, Youn TJ, et al. Efficacy of IntraCoronary Erythropoietin Delivery BEfore Reperfusion-Gauging Infarct Size in Patients with Acute ST-segment Elevation Myocardial Infarction (ICEBERG). Int Heart J. 2019 Mar 20;60(2):255-63.
• ⁶⁸
  Cung TT, Morel O, Cayla G, Rioufol G, Garcia-Dorado D, Angoulvant D, et al.Cyclosporine before PCI in Patients with Acute Myocardial Infarction. N Engl J Med. 2015 Sep 10;373(11):1021-31.
• ⁶⁹
  Ottani F, Latini R, Staszewsky L, La Vecchia L, Locuratolo N, Sicuro M, et al. CYCLE Investigators. Cyclosporine A in Reperfused Myocardial Infarction: The Multicenter, Controlled, Open-Label CYCLE Trial. J Am Coll Cardiol.2016;2;67(4):365-74.
• ⁷⁰
  Mohammed A, Cormack S, Penahi P, Das R, Egred M, Steel A et al. Effect of cyclosporine on lymphocyte kinetics a left ventricular remodelling in patients with acute myocardial infarction Eur Heart J. 2018;39:765.
• ⁷¹
  Upadhaya S, Madala S, Baniya R, Subedi SK, Saginala K, Bachuwa G. Impact of cyclosporine A use in the prevention of reperfusion injury in acute myocardial infarction: A meta-analysis. Cardiol J. 2017;24(1):43-50.
• ⁷²
  Kenjaev SR, Mirmaksudov M, Kenjaev ML, Alyavi AL, Maksudova MKH, Turg'unboyev SHB. Efficiency of quercetin in complex treatment of acute myocardial infarction with ST segment elevation Eur Heart J. 2018;39:958.
• ⁷³
  Khan AI, Kapoor A, Chen J, Martin L, Rogazzo M, Mercier T, et al. The Antimalarial Drug Artesunate Attenuates Cardiac Injury in A Rodent Model of Myocardial Infarction. Shock. 2018;49(6):675‐81.
• ⁷⁴
  Tanzilli G, Truscelli G, Arrivi A, Carnevale R, Placanica A, Viceconte N, et al. Glutathione infusion before primary percutaneous coronary intervention: a randomised controlled pilot study. BMJ Open. 2019 Aug 8;9(8):e025884.
• ⁷⁵
  Stähli BE, Gebhard C, Duchatelle V, Cournoyer D, Petroni T, Tanguay JF, et al.Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights From the SELECT-ACS Trial. J Am Heart Assoc. 2016 Nov 16;5(11):e004255.
• ⁷⁶
  Kleveland O, Kunszt G, Bratlie M, Ueland T, Broch K, Holte E, et al. Effect of a single dose of the interleukin-6 receptor Antagonista tocilizumab on inflammation and troponin T release in patients with non-ST-elevation myocardial infarction: a double-blind, randomized, placebo-controlled phase 2 trial. Eur Heart J.2016;37(30):2406-13.
• ⁷⁷
  Steppich B, Hadamitzky M, Ibrahim T, Groha P, Schunkert H, Laugwitz KL, et al. Regenerate Vital Myocardium by Vigorous Activation of Bone Marrow Stem Cells (REVIVAL-2) Study Investigators. Stem cell mobilisation by granulocyte-colony stimulating factor in patients with acute myocardial infarction. Long-term results of the REVIVAL-2 trial. Thromb Haemost. 2016;115(4):864-8.
• ⁷⁸
  Choudry F, Hamshere S, Saunders N, Veerapen J, Bavnbek K, Knight C, et al. A randomized double-blind control study of early intra-coronary autologous bone marrow cell infusion in acute myocardial infarction: the REGENERATE-AMI clinical trial. Eur Heart J. 2016;37(3):256-63.
• ⁷⁹
  Gao LR, Chen Y, Zhang NK, Yang XL, Liu HL, Wang ZG, et al. Intracoronary infusion of Wharton's jelly-derived mesenchymal stem cells in acute myocardial infarction: double-blind, randomized controlled trial. BMC Med. 2015;13:162.
• ⁸⁰
  San Roman JA, Sánchez PL, Villa A, Sanz-Ruiz R, Fernandez-Santos ME, Gimeno F, et al. Comparison of Different Bone Marrow-Derived Stem Cell Approaches In Reperfused STEMI. A Multicenter, Prospective, Randomized, Open-Labeled TECAM Trial. J Am Coll Cardiol. 2015;65(22):2372-82.
• ⁸¹
  Cong XQ, Li Y, Zhao X, Dai YJ, Liu Y. Short-Term Effect of Autologous Bone Marrow Stem Cells to Treat Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Clinical Trials. J Cardiovasc Transl Res. 2015;8(4):221-31.
• ⁸²
  Elbaz-Greener G, Sud M, Tzuman O, Leitman M, Vered Z, Ben-Dov N, et al. Adjunctive laser-stimulated stem-cells therapy to primary Reperfusion in acute myocardial infarction in humans: Safety and feasibility study. J Interv Cardiol. 2018;31(6):711-6.
• ⁸³
  ngstrøm T, Kelbæk H, Helqvist S, Høfsten DE, Kløvgaard L, Clemmensen P, et al.Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction–Ischemic Postconditioning (DANAMI-3–iPOST)Investigators. Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol. 2017;2(5):490-7.
• ⁸⁴
  Cao B, Wang H, Zhang C, Xia M, Yang X. Remote Ischemic Postconditioning (RIPC) of the Upper Arm Results in Protection from Cardiac Ischemia-Reperfusion Injury Following Primary Percutaneous Coronary Intervention (PCI)for Acute ST-Segment Elevation Myocardial Infarction (STEMI). Med Sci Monit. 2018;24:1017-26.
• ⁸⁵
  Mukherjee P, Jain M. Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: a single-center cross-sectional study. Ann Card Anaesth. 2019;22(4):347‐52.
• ⁸⁶
  McLeod SL, Iansavichene A, Cheskes S. Remote Ischemic Perconditioning to Reduce Reperfusion Injury During Acute ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2017;6(5): e005522.
• ⁸⁷
  Luz A, Santos M, Magalhães R, Oliveira JC, Pacheco A, Silveira J, et al. Soluble TNF-related apoptosis induced ligand (sTRAIL) is augmented by Post-Conditioning and correlates to infarct size and left ventricle dysfunction in STEMI patients: a substudy from a randomized clinical trial. Heart Vessels. 2017;32(2):117-25.
• ⁸⁸
  Araszkiewicz A, Grygier M, Pyda M, Rajewska J, Michalak M, Slawek-Szmyt S, et al. Postconditioning reduces infarct size and microvascular obstruction zone in acute ST-elevation myocardial infarction – A randomized study. Postepy kardiol interwencyjnej .2019;15(3):292-300.
• ⁸⁹
  Hausenloy DJ, Kharbanda RK, Møller UK, Ramlall M, Aarøe J, Butler, et al.CONDI-2/ERIC-PPCI Investigators. Effect of remote Ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.Lancet. 2019;394(10207):1415-24.
• ⁹⁰
  de Waha S, Eitel I, Desch S, Fuernau G, Pöss J, Schuler G, et al. Impact of multivessel coronary artery disease on reperfusion success in patients with ST-elevation myocardial infarction: A substudy of the AIDA STEMI trial. Eur Heart J Acute Cardiovasc Care. 2017;6(7):592-600.

• Study Association
  This study is not associated with any thesis or dissertation work.

• Sources of Funding: There were no external funding sources for this study.

Publication Dates

• Publication in this collection
  09 June 2021
• Date of issue
  Jan-Feb 2022

History

• Received
  27 July 2020
• Reviewed
  05 Aug 2020
• Accepted
  05 Aug 2020