Early coronary artery reperfusion improves outcomes for patients with ST-segment elevation myocardial infarction (STEMI), but morbidity and mortality after STEMI remain unacceptably high. The primary deficits seen in these patients include inadequate pump function, owing to rapid infarction of muscle in the first few hours of treatment, and adverse remodelling of the heart in the months that follow. Given that attempts to further reduce myocardial infarct size beyond early reperfusion in clinical trials have so far been disappointing, effective therapies are still needed to protect the reperfused myocardium. In this Review, we discuss several approaches to preserving the reperfused heart, such as therapies that target the mechanisms involved in mitochondrial bioenergetics, pyroptosis, and autophagy, as well as treatments that harness the cardioprotective properties of inhaled anaesthetic agents. We also discuss potential therapies focused on correcting the no-reflow phenomenon and its effect on healing and adverse left ventricular remodelling.

早期冠状动脉再灌注可改善 ST 段抬高型心肌梗死 (STEMI) 患者的预后，但 STEMI 后的发病率和死亡率仍然高得令人无法接受。这些患者的主要缺陷包括泵功能不足，这是由于治疗的最初几个小时内肌肉迅速梗塞，以及随后几个月内心脏的不良重塑。鉴于迄今为止在临床试验中进一步减少早期再灌注以外的心肌梗塞面积的尝试令人失望，因此仍然需要有效的治疗来保护再灌注的心肌。在这篇综述中，我们讨论了几种保护再灌注心脏的方法，例如针对线粒体生物能学、细胞焦亡和自噬相关机制的治疗，以及利用吸入麻醉剂的心脏保护特性的治疗。我们还讨论了侧重于纠正无复流现象及其对愈合和不良左心室重塑的影响的潜在疗法。