Targeted pharmacotherapy for ischemia reperfusion injury in acute myocardial infarction

Introduction Achieving reperfusion immediately after acute myocardial infarction improves outcomes; despite this, patients remain at a high risk for mortality and morbidity at least for the first year after the event. Ischemia–reperfusion injury (IRI) has a complex pathophysiology and plays an important role in myocardial tissue injury, repair, and remodeling.Areas covered In this review, the authors discuss the various mechanisms and their pharmacological agents currently available for reducing myocardial ischemia–reperfusion injury (IRI). They review important original investigations and trials in various clinical databases for treatments targeting IRI.Expert opinion Encouraging results observed in many preclinical studies failed to show similar success in attenuating myocardial IRI in large-scale clinical trials. Identification of critical risk factors for IRI and targeting them individually rather than one size fits all approach should be the major focus of future research. Various newer therapies like tocilizumab, anakinra, colchicine, revacept, and therapies targeting the reperfusion injury salvage kinase pathway, survivor activating factor enhancement, mitochondrial pathways, and angiopoietin-like peptide 4 hold promise for the future.