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Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
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Prevention of heart failure after acute myocardial infarction

Jacob A Udell1, M Cecilia Bahit2, Patricia Campbell3

  • 1Women's College Hospital, University of Toronto, Toronto, ON, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.

Lancet (London, England)
|September 1, 2025
PubMed

Insights

Significant advancements in preventing heart failure after acute myocardial infarction (AMI) have been achieved. Standard therapies reduce risk, but residual risk necessitates personalized treatment strategies for better outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Heart Failure Research

Background:

  • Acute myocardial infarction (AMI) remains a leading cause of heart failure.
  • Global care standards for AMI management, including timely reperfusion, have improved, reducing heart failure incidence.
  • Established therapies like renin-angiotensin-aldosterone system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists are crucial for post-AMI heart failure prevention.

Purpose of the Study:

  • To review epidemiological trends and pathological mechanisms of heart failure post-AMI.
  • To evaluate modern risk stratification tools for identifying high-risk individuals.
  • To propose a tailored treatment pathway and discuss future strategies for mitigating residual heart failure risk.

Main Methods:

  • Review of epidemiological data over four decades.
  • Analysis of evolving pathological mechanisms of heart failure.
  • Assessment of current risk stratification tools and therapeutic strategies.

Main Results:

  • Stepwise reductions in heart failure risk observed due to improved AMI management and reperfusion.
  • Demonstrated efficacy of specific drug classes in reducing post-AMI heart failure risk.
  • Persistence of residual heart failure risk despite optimal revascularization and medical therapies.

Conclusions:

  • While significant progress has been made, residual risk of heart failure post-AMI persists.
  • Personalized treatment pathways based on individual risk stratification are essential.
  • Future strategies are needed to further incrementally reduce the incidence of heart failure after acute myocardial infarction.

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