Author Affiliations: Heart Institute, Good Samaritan Hospital and Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles.
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
Kloner RA. Attempts to Recruit Stem Cells for Repair of Acute Myocardial InfarctionA Dose of Reality. JAMA. 2006;295(9):1058-1060. doi:10.1001/jama.295.9.1058