PREVENTION OF REPERFUSION INJURY IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION: THE CGMP PATHWAY


David Garcia-Dorado, M.D., Ph.D., Vall d'Hebron University Hospital, Barcelona, Spain

Despite standard-of-the-art reperfusión therapy, most patients with ST elevation myocardial infarction (STEMI) present significant myocardial necrosis, and many of them experience adverse left ventricular remodeling and adverse outcomes. Coadjuvant therapies able to limit necrosis in these patients by reducing reperfusion injury are thus of great potential clinical interest. Preclinical studies have produced a wealth of information demonstrating that the cyclic GMP (cGMP) - PKG signal pathway is depressed at the time of reperfusion, and that its pharmacological stimulation limits reperfusion injury and infarct size. Clinical studies have shown that this pharmacological approach is capable to limit infarct size in patients with STEMI undergoing reperfusion therapy. Moreover, recent data indicate that cGMP signaling may have an important role in the cardioprotection afforded by other therapeutic strategies that have been found also able to limit infarct size in these patients, including ischemic postconditioning and remote ischemic conditioning. This presentation analyzes recent advances in the understanding of the mechanisms of cGMP-mediated protection against reperfusion injury and new ways to exploit them to limit infarct size and improve the prognosis of patients with STEMI.