Method 1- Ischemic Post Treatment (IPost)

Research has found that performing IPost after PCI in AMI patients can reduce MI area. After implanting a stent at the site of the culprit lesion in patients with acute ST segment elevation myocardial infarction (STEMI), scholars such as Staat quickly contracted the balloon and withdrew it upstream of the stent, allowing blood flow to perfuse for 1 minute, and then expanded the balloon to terminate blood flow for 1 minute (this is one cycle). This was repeated for 4 cycles (a total of 8 minutes), and the final MI area was reduced by 36% according to myocardial enzyme evaluation. However, there is still no consensus on whether IPost can provide long-term benefits to patients, and the DANAMI-3 trial is currently underway.

Method 2- Atrial natriuretic peptide (ANP)

ANP treatment before vascular opening can reduce MI area in STEMI patients. A study published in Lancet included 569 AMI patients who were randomly divided into an ANP group and a placebo control group. ANP analogues and placebo interventions were given before vascular opening, respectively. The results showed that the ANP group reduced MI area by 14.7% and improved patient clinical outcomes. However, further research is needed to confirm whether ANP can improve patient clinical outcomes.

Method 3- Cyclosporine A (CsA)

Mitochondrial permeability transition pore (MPTP) is the main mediator of myocardial ischemia-reperfusion injury in AMI patients at the first minute. Theoretically, inhibiting the opening of MPTP can reduce myocardial mortality, which has been confirmed in some trials. Piot and other scholars applied this treatment method to clinical practice for the first time. Among them, 58 STEMI patients received intravenous injection of CsA before PCI and found that the MI area decreased by about 40%. However, the study did not find that CsA can improve the primary endpoint events (such as all-cause mortality, heart failure hospitalization rate, and worsening left ventricular remodeling) in patients with acute anterior wall STEMI. Further research is needed to determine whether MPTP inhibitors can be used clinically.

Method 4- Eseptide

Acesulfatide is a long-acting glucagon like peptide-1 analogue that can lower blood sugar by stimulating insulin secretion. Animal experiments have found that administering exenatide before myocardial reperfusion can promote myocardial cell survival by stimulating intracellular signaling pathways, thereby reducing MI area. Scholars such as Lonborg have found through myocardial magnetic resonance imaging that treating STEMI patients with exenatide 6 hours before PCI can reduce MI area by 30%. Whether exenatide can improve the clinical outcomes of STEMI patients still needs to be confirmed through large-scale clinical studies.

Method 5- Remote Ischemic Regulation (Transient Limb Ischemia/Reperfusion) (RIC)

Before PCI in STEMI patients, standard blood pressure cuff is tied to the upper arm or thigh, and brief non fatal ischemia and reperfusion (this is one cycle) are induced through cuff inflation and deflation. The ischemia and reperfusion time is 5 minutes each, and repeated for 3-4 cycles. This method is called RIC. Research has found that this method can stimulate intracellular signaling pathways, promote myocardial cell survival, and reduce MI area. Moreover, performing RIC before thrombolysis in STEMI patients can also reduce MI area. Animal experiments have found that performing RIC after MI can improve left ventricular remodeling, but whether this method can improve clinical outcomes is still under investigation.

Method 6- Metoprolol

Research has found that intravenous injection of metoprolol before PCI in STEMI patients can reduce MI area by 20%, but whether metoprolol can improve clinical outcomes still requires large-scale clinical trials.

Method 7- Composite reperfusion therapy

The above are all single treatment methods for myocardial reperfusion injury. Can a combination of multiple methods yield more benefits. Research has found that RIC combined with exenatide can reduce MI area by an additional 26%. In addition, it has been found that RIC combined with IPost can improve myocardial survival rate.