Inflammation in acute myocardial infarction: the good, the bad and the ugly

医学 炎症 心肌梗塞 重症监护医学 临床试验 疾病 冠状动脉疾病 卡那努马布 生物信息学 免疫学 心脏病学 内科学 阿纳基纳 生物
作者
M. Matter,Francesco Paneni,Peter Libby,Stefan Frantz,Barbara E. Stähli,Christian Templin,Alessandro Mengozzi,Yu-Jen Wang,Thomas M. Kündig,Lorenz Räber,Frank Ruschitzka,Christian M. Matter
出处
期刊:European Heart Journal [Oxford University Press]
卷期号:45 (2): 89-103 被引量:79
标识
DOI:10.1093/eurheartj/ehad486
摘要

Abstract Convergent experimental and clinical evidence have established the pathophysiological importance of pro-inflammatory pathways in coronary artery disease. Notably, the interest in treating inflammation in patients suffering acute myocardial infarction (AMI) is now expanding from its chronic aspects to the acute setting. Few large outcome trials have proven the benefits of anti-inflammatory therapies on cardiovascular outcomes by targeting the residual inflammatory risk (RIR), i.e. the smouldering ember of low-grade inflammation persisting in the late phase after AMI. However, these studies have also taught us about potential risks of anti-inflammatory therapy after AMI, particularly related to impaired host defence. Recently, numerous smaller-scale trials have addressed the concept of targeting a deleterious flare of excessive inflammation in the early phase after AMI. Targeting different pathways and implementing various treatment regimens, those trials have met with varied degrees of success. Promising results have come from those studies intervening early on the interleukin-1 and -6 pathways. Taking lessons from such past research may inform an optimized approach to target post-AMI inflammation, tailored to spare ‘The Good’ (repair and defence) while treating ‘The Bad’ (smouldering RIR) and capturing ‘The Ugly’ (flaming early burst of excess inflammation in the acute phase). Key constituents of such a strategy may read as follows: select patients with large pro-inflammatory burden (i.e. large AMI); initiate treatment early (e.g. ≤12 h post-AMI); implement a precisely targeted anti-inflammatory agent; follow through with a tapering treatment regimen. This approach warrants testing in rigorous clinical trials.
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