Journal: Journal of Clinical Medicine

Article Title: Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

doi: 10.3390/jcm10132968

Figure Lengend Snippet: Principal effects of pharmacological therapies and mechanical interventions on pathophysiological determinants of post-STEMI LVR. LVR: left ventricular remodeling; STEMI: ST elevation myocardial infarction; RAAS: renin angiotensin aldosterone system; SAC/VAL: sacubitril/valsartan; PCSK9: proprotein convertase subtilisin/kexin type 9; Gp IIb IIIa; glycoprotein IIb IIIa; RIPer-C: remote ischemic perconditioning; RIPost-C: remote ischemic post-conditioning; miRs: micro-RNAs. ↑ indicates an increase; ↓ indicates a decrease.

Article Snippet: Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far.

Techniques:

Journal: Journal of Clinical Medicine

Article Title: Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

doi: 10.3390/jcm10132968

Figure Lengend Snippet: Scheme for a reasoned multitarget therapeutic strategy against post-STEMI LVR, in the ‘pre-PCI’ and ‘during-pPCI’ phases. On the left side of the picture, the timing of conventional pharmacological therapy for STEMI patients is described, in the ‘pre-PCI’ and ‘during-pPCI’ phases, according to the European Society of Cardiology (ESC) guidelines. Each pharmacological indication is identified with its own class of recommendation and level of evidence. On the right side of the picture, perspective pharmacological therapies and mechanical interventions in order to further improve protection against post-STEMI LVR according to precise timing are listed. PCSK9 inhibitors, liraglutide, and RIPer-C should be administered in the ‘pre-PCI’ phase, whereas thrombus aspiration (especially in patients with high glycemic values) and adenosine (in case of no-reflow phenomenon) should be used in the ‘during-pPCI’ phase. STEMI: ST elevation myocardial infarction; pPCI: primary percutaneous intervention; LVR: left ventricular remodeling; PCSK9: proprotein convertase subtilisin/kexin type 9; RIPer-C: remote ischemic perconditioning; ASA: acetylsalicylic acid; UFH: unfractioned heparin; Gp IIb IIIa: glycoprotein IIb IIIa.

Article Snippet: Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far.

Techniques:

Journal: Journal of Clinical Medicine

Article Title: Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

doi: 10.3390/jcm10132968

Figure Lengend Snippet: Scheme for a reasoned multitarget therapeutic strategy against post-STEMI LVR in the ‘post-pPCI’ phase. In this picture, the timing of conventional pharmacological therapy for STEMI patients, in the ‘post-pPCI’ phase is described, according to the European Society of Cardiology (ESC) guidelines. Each pharmacological indication is identified with its own class of recommendation and level of evidence. In the gray rectangles, the perspective pharmacological therapies (ARNI, liraglutide, glifozins) and mechanical interventions (RIPost-C) in order to further improve protection against post-STEMI LVR according to precise timing are identified. STEMI: ST elevation myocardial infarction; pPCI: primary percutaneous intervention; LVR: left ventricular remodeling; ARNI: angiotensin receptor neprilysin inhibitor; RIPost-C: remote ischemic post-conditioning; PCSK9: proprotein convertase subtilisin/kexin type 9; ARBs: angiotensin receptor blockers; MRAs: mineralocorticoid receptor antagonists; DAPT: dual anti-platelet therapy; ASA: acetylsalicylic acid; LVEF: left ventricular ejection fraction.

Article Snippet: Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far.

Techniques: