Ischemic and reperfusion injuries of the heart underlie the pathogenesis of acute myocardial infarction (AMI) and sudden cardiac death. The mortality rate is still high and is 5-7% in patients with ST-segment elevation myocardial infarction. The review is devoted to pharmacological approaches to limitation of ischemic and reperfusion injuries of the heart. The article analyzes experimental evidence and the clinical data on the effects of P2Y12 receptor antagonists on the heart’s tolerance to ischemia/reperfusion in animals with coronary artery occlusion and reperfusion and also in patients with AMI. Chronic administration of ticagrelor prevented adverse remodeling of the heart. There is evidence that sphingosine-1-phosphate is the molecule that mediates the infarct-reducing effect of P2Y12 receptor antagonists. It was discussed a role of adenosine in the cardioprotective effect of ticagrelor.
Cardiac remodeling; Heart; Ischemia; Purinergic P2Y12 receptor antagonists; Reperfusion.
Copyright © 2022. The Korean Society of Cardiology.
Conflict of interest statement
The authors declare that they have no conflict of interest.
Caspase-1 inhibition by VX-765 administered at reperfusion in P2Y12 receptor antagonist-treated rats provides long-term reduction in myocardial infarct size and preservation of ventricular function.
Basic Res Cardiol. 2018 Jul 10;113(5):32. doi: 10.1007/s00395-018-0692-z.
Basic Res Cardiol. 2018.
Free PMC article.
Translation of experimental cardioprotective capability of P2Y12 inhibitors into clinical outcome in patients with ST-elevation myocardial infarction.
Basic Res Cardiol. 2021 May 26;116(1):36. doi: 10.1007/s00395-021-00870-y.
Basic Res Cardiol. 2021.
Infarct Size Following Treatment With Second- Versus Third-Generation P2Y12 Antagonists in Patients With Multivessel Coronary Disease at ST-Segment Elevation Myocardial Infarction in the CvLPRIT Study.
J Am Heart Assoc. 2016 May 31;5(6):e003403. doi: 10.1161/JAHA.116.003403.
J Am Heart Assoc. 2016.
Free PMC article.
Impact of new oral or intravenous P2Y12 inhibitors and clopidogrel on major ischemic and bleeding events in patients with coronary artery disease: a meta-analysis of randomized trials.
Atherosclerosis. 2014 Apr;233(2):568-578. doi: 10.1016/j.atherosclerosis.2014.01.017. Epub 2014 Jan 21.
[Reperfusion and postconditioning in acute ST segment elevation myocardial infarction. A new paradigm for the treatment of acute myocardial infarction. From bench to bedside?].
Arch Cardiol Mex. 2006 Oct-Dec;76 Suppl 4:S76-101.
Arch Cardiol Mex. 2006.