Early reperfusion therapy for myocardial infarction has transformed the treatment of this disease. The restoration of blood flow to the heart within hours after thrombotic coronary occlusion reduces infarct size, maintains cardiac function, and minimizes the risk of late heart failure and lethal arrhythmias. However, high success rates of coronary reperfusion, coupled with aggressive efforts to shorten the time from the manifestation of symptoms to the restoration of arterial blood flow, have brought us close to the practical limits of acute revascularization therapy for myocardial infarction.

Recent work by Kuhn et al. 1 underscores the influence of postinfarction cellular and molecular events on adverse cardiac remodeling and heart failure. An understanding of these events may lead to new strategies to improve outcomes that offer a therapeutic window of weeks rather than hours.