Background: Early reperfusion of the blocked vessel is critical to restore the blood flow to
the ischemic myocardium to salvage myocardial tissue and improve clinical outcome. This reperfusion
strategy after a period of ischemia, however, may elicit further myocardial damage named myocardial
reperfusion injury. The manifestations of reperfusion injury include arrhythmias, myocardial
stunning and micro-vascular dysfunction, in addition to significant cardiomyocyte death. It is suggested
that an overproduction of reactive oxygen species, intracellular calcium overload and inflammatory
cell infiltration are the most important features of myocardial ischemia-reperfusion injury.
Objective: In this review, various pharmacological interventions to treat myocardial reperfusion injury
including the antioxidant flavonols, hydrogen sulfide, adenosine, opioids, incretin-based therapies and
cyclosporin A which targets the mitochondrial permeability transition pore are discussed.
Conclusion: The processes involved in reperfusion injury might provide targets for improved outcomes
after myocardial infarction but thus far that aim has not been met in the clinic.
Keywords: Cardioprotection, ischemia-reperfusion, antioxidant, reactive oxygen species, flavonol, hydrogen sulfide, adenosine,
opioids, incretin-based therapies, cyclosporin A.
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