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4. Conclusions

From a theoretical mechanistic perspective, primary unloading of the infarcted heart would be expected to stimulate pro-survival responses in cardiomyocytes, while improving myocardial perfusion and preserving the cardiac ECM (Fig. 1). Some of the proposed effects are supported through experimental evidence in animal models. Obviously, the current evidence is insufficient to support primary unloading as an effective adjunctive strategy in high-risk patients with acute MI. Both robust clinical studies and well-executed mechanism-oriented experimental investigations are needed to test the effectiveness of this promising new therapeutic approach.