In essence, a reduction in infarct size has been sought through three different approaches: reduction in myocardial energy demands, stimulation of anaerobic glycolytic energy production, and reperfusion in order to re-establish blood supply and, hence, oxygen availability. Since the most critical substrate lacking in infarcting myocardium is oxygen, early reperfusion to re-establish blood supply and oxygen availability is the most promising approach to infarct reduction. The beneficial effect of this treatment, that is, salvage of infarcting myocardial tissue, depends on the ischemic period as well as on the presence of collaterals. Successful reperfusion also leads to marked attenuation of increased sympatho-neuronal and sympatho-adrenal activities.
Address correspondence and reprint requests to Professor Dr. W. Kübler at Medizinische Klinik, Bergheimer Straβe 58, 69 Heidelberg, Federal Republic of Germany.
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