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Myocardial regeneration

Myocardial regeneration. Potential cells for repair: Skeletal muscles. Fetal cardiomyocyte . Embryonic stem cells. Bone marrow stromal cells. Endothelial progenerator cells. Skeletal myoblasts transplantation in animal model - rats. Infarction After transplantation.

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Myocardial regeneration

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  1. Myocardial regeneration • Potential cells for repair: • Skeletal muscles. • Fetal cardiomyocyte. • Embryonic stem cells. • Bone marrow stromal cells. • Endothelial progenerator cells.

  2. Skeletal myoblasts transplantation in animal model - rats Infarction After transplantation Taylor et al, Nature Medicine 1998;4:929

  3. Myocardial regeneration • Bodo E. Strauer et al: Circ 2002;106:1913: • 20 patients with AMI 5-9 days . • IC infusion of Autologous, mononuclear BMCs via a balloon catheter. • The main cells infused: AC 133, and CD 34 positive cells.

  4. Syringe containing Adult stem cells LAD Balloon Catheter Border Zone Infarcted Zone Cell transplantation into infarcted myocardium Bodo E. Strauer et al: Circ 2002;106:1913

  5. Improved myocardial perfusion 3 months after intra-coronary cell transplantation by 201Thallium scintigraphy Pre Post Bodo E. Strauer et al: Circ 2002;106:1913

  6. Myocardial regeneration • Bodo E. Strauer et al: Circ 2002;106:1913: • Results: • Decreased infarct size. 30% to 12% . P=0.005. • Improved myocardial perfusion. • Improved wall motion. 2 to 4 cm/sec. P=0.028.

  7. Myocardial preservation

  8. Myocardial preservation • Drowning in cold water improves survivals compared to warm water. • In cardiac arrest, induced hypothermia reduces neurological injury (NEJM 2002;346:557) • COOL MI ( Radiant medical) • ICE-IT (Innercool therapies)

  9. Reprieve TM Endovascular Temperature Therapy System

  10. CONCLUSION-1 Acute Coronary Syndromes are clinical entities with significant morbidity and mortality. Coronary artery plaque disruption and thrombosis are pathognomonic features of ACS. Early risk stratification is an important step in the management of ACS.

  11. CONCLUSION-2 • Acute reperfusion therapy with thrombolytic agent or primary angioplasty is the standard of care for STEMI patients. • The key to successful reperfusion lies more in the efficiency of delivery than in the choice of modality • In the Developed and more in the developing countries significant under-utilization and delays of reperfusion strategies have been identified.

  12. CONCLUSION-3 • Door to Needle time should not exceed 30 min • Door to Balloon time should not exceed 90 min • Tools and means: • Media campaign, patient education • Adequate EMS transport system • Well established Emergency Department chest pain protocol • Partnership between ED and cardiology personnel • Institution of pre-hospital rapid assessment, EKG and thrombolytic therapy protocol • Pre-arrival alert to ED/cardiology

  13. CONCLUSION-4 Aggressive Clopidogrel loading and a longer duration of therapy have been suggested with clear efficacy and safety Enoxaparin is preferable to UFH as an anticoagulant in patients with ACS. Newer Agents: Bivalirudin, Fondaparinux have shown benefit in the management of ACS, with significant safety. An early invasive approach with PCI is favored over initial conservative management. Above all aggressive risk factors’ modifications are CRITICAL.

  14. Thank you

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