Remodeling after reperfused myocardial infarction: What more can we do?

Despite reperfusion and pharmacotherapy, cardiac enlargement and heart failure remain problematic in survivors of ST-elevation myocardial infarction (STEMI). Without reperfusion, damage to the extracellular matrix (ECM) and myocardium results in aneurysm formation. With early reperfusion, benefits include less transmural MI, less ECM damage, less remodeling, more rapid healing and better overall long-term prognosis. However, with delayed reperfusion, reperfusion injury, persistent LV dysfunction, inflammation, increased matrix metalloproteinases (MMPs), ECM damage, and increased ruptures can be problematic. Dual anti-platelet therapy improves reperfusion and prevents reocclusion. Adding early ACE and/or ARBs and MMP inhibitors may preserve more myocardium and ECM, and more effectively limit adverse remodeling.