Mechanisms of myocardial ischemia-reperfusion injury

There is no doubt that prompt reperfusion is the key to salavaging more myocardium after a coronary occlusion as in acute myocardial infarction. Yet the rapid restoration of flow to an ischemic myocardium can also trigger the sequence of ischemia-reperfusion injury with deleterious consequences like further myocardial necrosis. Some of the pathologic and molecular basis of myocardial ischemia-reperfusion injury are injury from reactive oxygen species, inflammation, calcium overload, endothelial dysfunction and impaired microvascular flow [1]. Impaired microvascular flow manifests as the dreaded ‘no reflow phenomenon’ after primary angioplasty.

Reference

1. Welt FGP, Batchelor W, Spears JR, Penna C, Pagliaro P, Ibanez B, Drakos SG, Dangas G, Kapur NK. Reperfusion Injury in Patients With Acute Myocardial Infarction: JACC Scientific Statement. J Am Coll Cardiol. 2024 Jun 4;83(22):2196-2213. doi: 10.1016/j.jacc.2024.02.056. PMID: 38811097.