Pexelizumab

Reperfusion serves as a mainstay therapy in almost all ischemic vascular diseases (IVD), but reperfusion may enhance cell damage after an ischemic period time. Increased ROS and inflammatory markers, decreasing organ function parameters, along with systemic inflammatory response and multi-organ damage may occur in ischemic reperfusion injury (IRI). Unfortunately, this series of events is unpredictable and sudden, causing high mortality in patients with IRI. Due to the significant role of inflammation in IRI, how is the effectiveness of anti-inflammatory agents administered before reperfusion therapy to prevent IRI? To know the efficacy of anti-inflammatory agents administered before reperfusion therapy to prevent IRI.

A systematic search was conducted in databases (Pubmed, EMBASE, Scopus) and was later selected according to predetermined inclusion and exclusion criteria. Studies included later critically appraised using the CEBM Oxford questionnaire for randomized control trials and systematic review.

Seven studies were included among 1072 studies found in early searching. Six of the studies are randomized control trials, and one is a meta-analysis of randomized control trials. Methylprednisolone, pexelizumab, tirilazad mesylate, and N-acetylcysteine are known anti-inflammatory agents applicable in humans. The highest effectiveness of anti-inflammatory agents is methylprednisolone, with a relative risk reduction (RRR) of 75-85%. Besides that, pexelizumab also had an RRR of 27%, and tirilazad-mesylate had an RRR of 18%. N-acetylcysteine is not effective in preventing IRI. IL-6 levels postoperatively also decreased significantly in patients given anti-inflammatory agents before reperfusion therapy. There are no side effects of the intervention reported.

Anti-inflammatory agent administration before reperfusion therapy effectively prevents IRI. The choices of anti-inflammatory agents recommended are methylprednisolone, pexelizumab, and tirilazad-mesylate. Anti-inflammatory agent administration before reperfusion therapy is recommended.

Despite significant advances in the treatment of ST elevation myocardial infarction (STEMI), there remains a significant short-term and long-term increased mortality risk. Risk stratification to target those who may benefit from more intensive therapy postrevascularisation therefore remains an important goal. Risk stratification models in acute coronary syndrome (ACS) have been researched for many years, but few risk scores have been developed and validated specifically for the STEMI population. Only 27% of the cohort for the Global Registry of Acute Coronary Events (GRACE) score was derived from those undergoing percutaneous intervention (PCI), and the GRACE score performs less accurately in those undergoing PCI compared with medical therapy. Nevertheless European1 (but not American2) guidelines recommend its use for clinical risk stratification in the STEMI cohort. Risk scores derived specifically for STEMI include the Global Utilization of Streptokinase and Tissue plasminogen activator to treat Occluded arteries (GUSTO) risk score, which was developed in the era of thrombolysis, while risk scores assessing mortality in primary PCI patients include the Primary Angioplasty in Myocardial Infarction (PAMI) risk score, Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score, Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) score, Soroka Acute Myocardial Infarction (SAMI) score, and the Zwolle risk score. Coelho-Lima and colleagues3 examine the prognostic value of troponin specifically in the STEMI population, a group where troponin is not used to guide initial treatment. Their major findings are that admission troponin, but not troponin measured 12 hours post-reperfusion, was a significant independent predictor of both inpatient or overall mortality, with a median follow-up time of over 4 years. The authors are to be commended for this large retrospective study—in particular, the clinical …