Tissue reperfusion after ST-Elevation Myocardial Infarction (STEMI): Autoimmunity could explain the unexplainable

Author(s): Giovanni Civieri, Sabino Iliceto, Francesco Tona

ST-Elevation Myocardial Infarction (STEMI) is a major cause of premature death and morbidity. Although percutaneous coronary interventions are lifesaving, in up to 40% of patients reopening of the epicardial coronary artery doesn’t guarantee successful reperfusion of the myocardium. This phenomenon is called no-reflow and is a neglected problem in modern medicine. It has been recently demonstrated that autoantibodies targeting endothelin-1 type A receptor, by exerting their detrimental effects through vasoconstriction, fibrosis and inflammation, are associated with no-reflow. This finding provided, for the first time, evidence of an autoimmune predisposition to a worse outcome after myocardial infarction, creating opportunities to future therapeutic implications.