Targeting Inflammation After Myocardial Infarction
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MANAGEMENT OF ACUTE CORONARY SYNDROMES (H JNEID, SECTION EDITOR)
Targeting Inflammation After Myocardial Infarction Dhruv Mahtta 1,2 & Deepthi Sudhakar 2 & Srikanth Koneru 3 & Guilherme Vianna Silva 3 & Mahboob Alam 3 & Salim S. Virani 1,2,4 & Hani Jneid 2,4
# This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Purpose of Review Inflammation plays a key role in clearing cellular debris and recovery after acute myocardial infarction (AMI). Dysregulation of or prolonged inflammation may result in adverse cardiac remodeling and major adverse clinical events (MACE). Several pre-clinical studies and moderate sized clinical trials have investigated the role of immunomodulation in improving clinical outcomes in patients with AMI. Recent Findings Clinical data from the Canakinumab Atherothrombosis Outcome (CANTOS) and Colchicine Cardiovascular Outcomes Trial (COLCOT) have provided encouraging results among patients with AMI. Several other clinical and pre-clinical trials have brought about the prospect of modulating inflammation at various junctures of the inflammatory cascade including inhibition of complement cascade, interleukins, and matrix metalloproteinases. Summary In patients with AMI, modulation of residual inflammation via various inflammatory pathways and mediators may hold promise for further reducing MACE. Learning from current data and understanding the nuances of immunomodulation in AMI are key for future trials and before widespread dissemination of such therapies. Keywords Myocardial infarction . Inflammation . Anti-inflammatory . Immunomodulation . Cardiac remodeling
Introduction Ischemic heart disease remains the leading cause of global morbidity with acute myocardial infarction (AMI) affecting greater than 7 million patients worldwide [1]. With advancements and implementation of reperfusion therapies among patients presenting with AMI, there has been a considerable
reduction in associated mortality [2]. However, this reduction in acute mortality has expanded the pool of patients who, although surviving the index event, remain at risk for future incident heart failure and recurrent ischemic events. Although timely reperfusion via primary percutaneous coronary intervention (PPCI) is effective in minimizing infarct size and salvaging viable myocardium [3], modulation of the ensuing
This article is part of the Topical Collection on Management of Acute Coronary Syndromes * Hani Jneid [email protected] Dhruv Mahtta [email protected]
Salim S. Virani [email protected] 1
Health Policy, Quality & Informatics Program,, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
Srikanth Koneru [email protected]
2
Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, TX, USA
Guilherme Vianna Silva [email protected]
3
Division of Cardiovascular Medicine,, Texas Heart Institute and Baylor College of Medicine, Hous
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