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Reperfusion injury of the heart

Duane S Pinto, MD, MPH
C Michael Gibson, MS, MD
Section Editors
Derek M Yellon, PhD, DSc, Hon FRCP, FACC, FESC
Derek J Hausenloy, MD, PhD, FRCP, FACC, FESC
Deputy Editor
Gordon M Saperia, MD, FACC


Myocardial injury in the setting of an acute myocardial infarction is the result of ischemic and reperfusion injury. Reperfusion therapies, including primary percutaneous coronary intervention and fibrinolytic therapy, promptly restore blood flow to ischemic myocardium and limit infarct size.

Paradoxically, however, the return of blood flow can result in additional cardiac damage and complications; this is referred to as reperfusion injury [1-3]. Effective therapies to reduce or prevent reperfusion injury have proven elusive. Despite an improved understanding of the pathophysiology of this process and encouraging preclinical trials of multiple agents, most of the clinical trials to prevent reperfusion injury have been disappointing [4-6]. Despite these problems, adjunctive therapies to limit reperfusion injury remain an active area of investigation.

This topic will discuss the pathophysiology and manifestations of reperfusion injury, as well as potential therapeutic strategies. The impact of the initial ischemic insult is discussed separately. (See "Angina pectoris: Chest pain caused by myocardial ischemia", section on 'Pathophysiology of myocardial ischemia'.)

General discussions of the use of reperfusion therapy in acute myocardial infarction are presented separately. (See "Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Determinants of outcome" and "Fibrinolysis for acute ST elevation myocardial infarction: Initiation of therapy".)


In the first stage of acute myocardial infarction, myocardial cells are injured as the result of anoxia and the absence of new essential metabolic substrate. In the absence of reperfusion, and in the absence of an adequate collateral circulation, these injured cells die and scar tissue is formed.

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Literature review current through: Nov 2017. | This topic last updated: Oct 03, 2017.
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