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. 2021 Jul 1;10(13):2968. doi: 10.3390/jcm10132968

Figure 3.

Figure 3

Scheme for a reasoned multitarget therapeutic strategy against post-STEMI LVR, in the ‘pre-PCI’ and ‘during-pPCI’ phases. On the left side of the picture, the timing of conventional pharmacological therapy for STEMI patients is described, in the ‘pre-PCI’ and ‘during-pPCI’ phases, according to the European Society of Cardiology (ESC) guidelines. Each pharmacological indication is identified with its own class of recommendation and level of evidence. On the right side of the picture, perspective pharmacological therapies and mechanical interventions in order to further improve protection against post-STEMI LVR according to precise timing are listed. PCSK9 inhibitors, liraglutide, and RIPer-C should be administered in the ‘pre-PCI’ phase, whereas thrombus aspiration (especially in patients with high glycemic values) and adenosine (in case of no-reflow phenomenon) should be used in the ‘during-pPCI’ phase. STEMI: ST elevation myocardial infarction; pPCI: primary percutaneous intervention; LVR: left ventricular remodeling; PCSK9: proprotein convertase subtilisin/kexin type 9; RIPer-C: remote ischemic perconditioning; ASA: acetylsalicylic acid; UFH: unfractioned heparin; Gp IIb IIIa: glycoprotein IIb IIIa.