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Attempts to Recruit Stem Cells for Repair of Acute Myocardial Infarction
A Dose of Reality
Robert A. Kloner, MD, PhD
JAMA. 2006;295:1058-1060.
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Experimental studies suggest that most of the myocardial cells destined to die following an acute coronary artery occlusion will do so within 3 to 6 hours.1 Early coronary reperfusion with thrombolytic therapy, angioplasty, and/or stenting can certainly salvage ischemic myocardium and improve clinical outcome but late reperfusion will not salvage myocardium. However, there are therapies for which strong evidence has demonstrated benefit even when started beyond 24 hours. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers reduce the risk of heart failure and premature death, presumably by decreasing progressive left ventricular dilatation and remodeling.2-3 Other established and effective adjunctive therapies include antiplatelet agents and statins.4
A relatively new and exciting concept for late treatment of acute myocardial infarction (AMI) is that the thin, noncontractile collagenous scar that results after myocyte death could be replaced by viable, contracting myocardium (ie, the damaged heart can be rebuilt). Early . . . [Full Text of this Article]
Author Affiliations: Heart Institute, Good Samaritan Hospital and Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles.
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