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How to best counteract the enemies? By ensuring adequate oxygen delivery

F.-J. Neumann* and N. Jander

Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany

* Correspondence: F.-J. Neumann, Herz-Zentrum Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany.

Abstract

Shortage of oxygen supply due to inadequate perfusion induces depressed contractile function in viable myocardium (hibernation) or myocardial cell death (myocardial infarction). The present review addresses the role of revascularization in the prevention of myocardial infarction in acute coronary syndromes, optimization of myocardial salvage once myocardial infarction has occurred, and treatment of hibernating myocardium. In acute coronary syndromes, the risk for death and myocardial infarction can be reduced by systematic revascularization in combination with modern antithrombotic treatment (early invasive strategy). In acute myocardial infarction, myocardial salvage can be maximized by stent-supported angioplasty in combination with glycoprotein IIb/IIIa receptor blockade. If hibernating myocardium is identified by dobutamine echocardiography, nuclear imaging techniques or magnet resonance imaging, then revascularization will improve contractile function and long-term outcome in most patients.

Key Words: Glycoprotein IIb/IIIa • hibernation • myocardial infarction • nuclear magnetic resonance imaging • platelets • unstable angina

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