Related Experiment Video
Updated: Jun 26, 2026
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Benefits of reperfusion beyond infarct size limitation
Genzou Takemura1, Munehiro Nakagawa, Hiromitsu Kanamori
1Division of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan. gt@gifu-u.ac.jp
Insights
Late reperfusion after myocardial infarction (MI) may not improve outcomes, despite some evidence. Further research is needed to clarify its benefits and optimize clinical application for better patient prognosis.
Area of Science:
- Cardiology
- Pathophysiology
- Clinical Trials
Background:
- Prognosis after acute myocardial infarction (MI) is primarily determined by infarct size.
- The 'open artery hypothesis' suggests late reperfusion may benefit left ventricular remodeling and mortality, even if myocardium isn't salvaged.
- Recent clinical trials have challenged the efficacy of late reperfusion therapy.
Purpose of the Study:
- To review the effects of late reperfusion on myocardial infarction (MI) pathophysiology.
- To analyze infarct tissue dynamics and clinical outcomes related to late reperfusion.
- To identify factors for improving clinical application of late reperfusion strategies.
Main Methods:
- Review of experimental and clinical evidence regarding late reperfusion in acute myocardial infarction (MI).
- Analysis of recent large, randomized clinical trials on late reperfusion therapy.
- Discussion of pathophysiology, infarct tissue dynamics, and clinical outcomes.
Main Results:
- Conflicting evidence exists regarding the benefits of late reperfusion after acute myocardial infarction (MI).
- Some studies suggest benefits for left ventricular remodeling and mortality, while recent trials refute clinical efficacy.
- Heterogeneity in reperfusion timing and infarct size, and need for sustained artery patency are critical issues.
Conclusions:
- The clinical efficacy of late reperfusion for acute myocardial infarction (MI) remains controversial.
- Revised clinical studies with controlled reperfusion timing and infarct size are necessary.
- Further research is required to resolve issues and improve the clinical application of late reperfusion.
Abstract:
The most critical determinant of prognosis in patients with acute myocardial infarction (MI) is infarct magnitude, which can be established within several hours of an attack. The importance of the subsequent healing process is not negligible, however. In fact, much experimental and clinical evidence suggests that late reperfusion of the infarct-related coronary artery--i.e. at times too late to salvage the myocardium within the area at risk-is beneficial for reducing left ventricular remodelling and decreasing mortality ('open artery hypothesis'). For instance, one recent study highlighted the beneficial effects of late reperfusion therapy on the infarct tissue cell dynamics following acute MI. Nonetheless, several recent large, randomized clinical trials have failed to provide evidence of such benefits, refuting the clinical efficacy of late reperfusion. In addition, they also underscore the need for revised clinical studies in which there is less heterogeneity in the timing of reperfusion and in the initial infarct size, as well as the need for sustained patency of the recanalized artery. This review focuses on the effects of late reperfusion on the pathophysiology of MI in the context of the infarct tissue dynamics and clinical outcomes. We also discuss the issues that need to be resolved to improve clinical application.
More Related Videos
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021