Abstract
The primary goal in reopening an infarct-related artery is the restoration of myocardial tissue-level perfusion. In a variable proportion of patients with ST-elevation myocardial infarction, however, microcirculatory impairment may persist after epicardial coronary artery recanalization. This phenomenon is known as microvascular obstruction (MVO). Ischemic injury, reperfusion injury, and distal embolization along with the individual response to each of these mechanisms are variably involved in the pathogenesis of MVO in the single patient. Importantly, MVO is associated with a worse prognosis both at short- and long-term follow-up. MVO can be assessed in the cath-lab by simple angiographic indexes, such as Thrombolysis in Myocardial Infarction grade score and Myocardial Blush Grade, or by invasive measures of coronary flow pattern. Imaging techniques, such as myocardial contrast echocardiography or cardiac magnetic resonance, and ST-segment resolution on standard electrocardiogram are used in the days following reperfusion with the patient in the coronary care unit. In this article, we review the available data regarding pathogenesis, diagnosis and the prognostic significance of MVO after primary percurtaneous coronary intervention in ST-elevation myocardial infarction patients, with a brief highlighting on the crucial role of its prevention and its early detection.
Keywords: ST-elevation myocardial infarction, primary percutaneous coronary intervention, microvascular obstruction, pathogenesis, diagnosis, prognosis
Current Vascular Pharmacology
Title:Microvascular Obstruction After Primary Percutaneous Coronary Intervention: Pathogenesis, Diagnosis and Prognostic Significance
Volume: 11 Issue: 2
Author(s): Giampaolo Niccoli, Nicola Cosentino, Silvia Minelli, Leonardo Cataneo and Filippo Crea
Affiliation:
Keywords: ST-elevation myocardial infarction, primary percutaneous coronary intervention, microvascular obstruction, pathogenesis, diagnosis, prognosis
Abstract: The primary goal in reopening an infarct-related artery is the restoration of myocardial tissue-level perfusion. In a variable proportion of patients with ST-elevation myocardial infarction, however, microcirculatory impairment may persist after epicardial coronary artery recanalization. This phenomenon is known as microvascular obstruction (MVO). Ischemic injury, reperfusion injury, and distal embolization along with the individual response to each of these mechanisms are variably involved in the pathogenesis of MVO in the single patient. Importantly, MVO is associated with a worse prognosis both at short- and long-term follow-up. MVO can be assessed in the cath-lab by simple angiographic indexes, such as Thrombolysis in Myocardial Infarction grade score and Myocardial Blush Grade, or by invasive measures of coronary flow pattern. Imaging techniques, such as myocardial contrast echocardiography or cardiac magnetic resonance, and ST-segment resolution on standard electrocardiogram are used in the days following reperfusion with the patient in the coronary care unit. In this article, we review the available data regarding pathogenesis, diagnosis and the prognostic significance of MVO after primary percurtaneous coronary intervention in ST-elevation myocardial infarction patients, with a brief highlighting on the crucial role of its prevention and its early detection.
Export Options
About this article
Cite this article as:
Niccoli Giampaolo, Cosentino Nicola, Minelli Silvia, Cataneo Leonardo and Crea Filippo, Microvascular Obstruction After Primary Percutaneous Coronary Intervention: Pathogenesis, Diagnosis and Prognostic Significance, Current Vascular Pharmacology 2013; 11 (2) . https://dx.doi.org/10.2174/1570161111311020013
DOI https://dx.doi.org/10.2174/1570161111311020013 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
TREATMENT OF CARDIOVASCULAR DISEASE IN CHRONIC AND END STAGE KIDNEY DISEASE
Cardiovascular disease still remains the leading cause of death in Chronic and End Stage Kidney Disease, accounting for more than half of all deaths in dialysis patients. During the past decade, research has been focused on novel therapeutic agents that might delay or even reverse cardiovascular disease and vascular calcification, ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Drugs Interfering with Apoptosis in Breast Cancer
Current Pharmaceutical Design Structure and Function of Poly(ADP-ribose) Polymerase-1: Role in Oxidative Stress-Related Pathologies
Current Vascular Pharmacology The HVJ-Envelope as an Innovative Vector System for Cardiovascular Disease
Current Gene Therapy Oxidative Stress, Antioxidants, and Endothelial Function
Current Medicinal Chemistry Scientific and Clinical Challenges in Sepsis
Current Pharmaceutical Design Targeting Neurite Growth Inhibitors to Induce CNS Regeneration
Current Pharmaceutical Design Protective Substances Against Zinc-Induced Neuronal Death after Ischemia:Carnosine as a Target for Drug of Vascular Type of Dementia
Recent Patents on CNS Drug Discovery (Discontinued) Histone Methylation and Transcriptional Regulation in Cardiovascular Disease
Cardiovascular & Hematological Disorders-Drug Targets Complement and Microglia in the Neuropathogenesis of HIV Infection: Pro- and Anti-Inflammatory Aspects
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry Mass Spectrometric Quantification of Urinary Netrin-1 Protein in Renal Transplant Recipients
Current Proteomics Mitochondria-targeted Resveratrol Derivatives Act as Cytotoxic Pro-oxidants
Current Pharmaceutical Design ATP-Sensitive K+ Channel Openers: Old Drugs with New Clinical Benefits for the Heart
Current Vascular Pharmacology Brainstem Neuropeptides and Vagal Protection of the Gastric Mucosal Against Injury: Role of Prostaglandins, Nitric Oxide and Calcitonin-Gene Related Peptide in Capsaicin Afferents
Current Medicinal Chemistry Platelet Activation, Inflammatory Mediators and Hypercholesterolemia
Current Vascular Pharmacology Involvement of L-Carnitine in Cellular Metabolism: Beyond Acyl-CoA Transport
Mini-Reviews in Medicinal Chemistry Advances in Inhibitors of FXa
Current Drug Targets TRP Channels as Therapeutic Targets in Kidney Disease and Hypertension
Current Topics in Medicinal Chemistry Targeting Vascular Redox Biology Through Antioxidant Gene Delivery: A Historical View and Current Perspectives
Recent Patents on Cardiovascular Drug Discovery Pathophysiology of Idiopathic Atrial Fibrillation - Prognostic and Treatment Implications
Current Pharmaceutical Design Phosphoinositide 3-Kinase Gamma (PI3Kγ) Inhibitors for the Treatment of Inflammation and Autoimmune Disease
Recent Patents on Inflammation & Allergy Drug Discovery