Heart Failure Reviews

, Volume 13, Issue 4, pp 439–452 | Cite as

Pleiotropic effects of cardiac drugs on healing post-MI. The good, bad, and ugly



Healing after myocardial infarction (MI) is a well-orchestrated time-dependent process that involves inflammation, tissue repair with extracellular collagen matrix (ECCM) deposition and scar formation, and remodeling of myocardial structure, matrix, vasculature, and function. Rapid early ECCM degradation followed by slow ECCM replacement and maturation during post-MI healing results in a prolonged window of enhanced vulnerability to adverse remodeling. Decreased ECCM results in adverse ventricular remodeling, dysfunction, and rupture. Inflammation, a critical factor in normal healing, if impaired results in adverse remodeling and rupture. Several therapeutic drugs prescribed after MI exert pleiotropic effects that suppress ECCM and inflammation during healing and may have good, bad, or ugly consequences. This article reviews the potential impact of pleiotropic effects of some prototypic cardiac drugs such as renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, and thrombolytics during healing post-ST-segment-elevation MI (STEMI), with special focus on inflammation, ECCM and remodeling, and implications in the elderly.


STEMI Healing Inflammation Extracellular collagen matrix Prototypic drugs Remodeling Aging 



This work was supported in part by a grant from the Heart and Stroke Foundation of Canada. I am indebted to C. Jugdutt for assistance with manuscript preparation.


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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Medicine and Cardiovascular Research Group, Faculty of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Division of Cardiology, 2C2 Walter MacKenzie Health Sciences CentreUniversity of AlbertaEdmontonCanada

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