Ischemia/reperfusion injury: Pharmacological treatment options

[Pages:32]Physiologisches Institut

Ischemia/reperfusion injury: Pharmacological treatment

options

PD Dr. Kerstin Boengler

Plaque rupture and myocardial ischemia

Acute plaque rupture (Stary VI)

Ischemic myocardium (ACS, NSTEMI, STEMI)

Plaque ruptur, thrombosis and myocardial death

Stable plaque Unstable plaque, plaque ruptur

% MI-Patients

75

60

45 68

30

15

18

14

0

< 50

50-70

> 70

Diameter stenosis (%)

Falk et al., Circulation 92: 657-671, 1995

Ischemic injury

Myocardial damage

TIME IS MUSCLE

Ischemia

IschemicInjury

Time

Ischemia-reperfusion injury

Ischemia

Infarct size (% area at risk)

100

80

Pig Rabbit

Humans

60 Rat

40

20 0 0 20

Dog

Cat

Guinea pig

45

90

180

Extent of collaterals

360 (min)

Schaper et al., Prog Cardiovasc Dis 31: 57-77,1988

Patient

Myocardial infarction and prognosis

6 Month mortality (%)

Infarct size (% area at risk)

Burns et al., J Am Coll Cardiol 39:30?36, 2002

Patient

CHD

Duration of ischemia and mortality

Mortality (%)

Cumulative mortality (Kaplan-Meier) in patients with STEMI and PCI (n=6.209)

30

Duration of ischemia

in minutes

20

0-60

61-120

121-180

10

181-360

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