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Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction

Giovanni Luigi De Maria1, Hector M Garcia-Garcia2, Roberto Scarsini3

  • 1Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK.

European Heart Journal. Acute Cardiovascular Care
|March 24, 2021
PubMed

Insights

New device-based therapies aim to improve outcomes for ST-elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI). These treatments target key issues like distal embolization and microvascular injury to enhance myocardial reperfusion and long-term prognosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Primary percutaneous coronary intervention (PPCI) has improved ST-elevation myocardial infarction (STEMI) outcomes, but prognosis remains suboptimal.
  • Significant rates of heart failure, cardiogenic shock, and death persist despite technically successful PPCI.
  • Suboptimal myocardial reperfusion, large infarct size, and coronary microvascular injury contribute to poor long-term prognosis in STEMI survivors.

Purpose of the Study:

  • To review novel device-based therapies for STEMI.
  • To discuss technologies targeting distal embolization, ischemia/reperfusion injury, and microvascular function.
  • To critically evaluate the evidence and future clinical implementation of these novel STEMI treatments.

Main Methods:

  • Literature review of device-based therapies for STEMI.
  • Categorization of therapies based on targeted pathophysiological pathways.
  • Analysis of pathophysiological background, procedural details, and available evidence.

Main Results:

  • Several device-based therapies are emerging to address suboptimal reperfusion in STEMI.
  • Technologies focus on preventing atherothrombotic embolization, mitigating ischemia/reperfusion injury, and enhancing microvascular function.
  • Evidence for these novel therapies varies, requiring further critical evaluation.

Conclusions:

  • Device-based therapies represent a promising approach to improve STEMI patient outcomes beyond current PPCI.
  • Targeting microvascular injury and distal embolization is crucial for enhancing myocardial reperfusion.
  • Further research and clinical trials are needed to establish the role of these technologies in routine STEMI care.

Keywords:
Device-based therapiesInfarct sizeIschaemia–reperfusion injuryMicrovascular injuryST-elevation myocardial infarction

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