Optimized treatment of ST-elevation myocardial infarction the unmet need to target coronary microvascular obstruction as primary treatment goal to further improve prognosis

Filippo Crea, Giampaolo Niccoli, Rocco Antonio Montone, Borja Ibanez, Holger Thiele, Gerd Heusch, Heerajnarain Bulluck, Derek J. Hausenloy, Colin Berry, Thomas Stiermaier, Paolo G. Camici, Ingo Eitel

Risultato della ricerca: Contributo in rivistaArticolo in rivista

38 Citazioni (Scopus)

Abstract

Primary percutaneous coronary intervention is nowadays the preferred reperfusion strategy for patients with acute ST-segment–elevation myocardial infarction, aiming at restoring epicardial infarct-related artery patency and achieving microvascular reperfusion as early as possible, thus limiting the extent of irreversibly injured myocardium. Yet, in a sizeable proportion of patients, primary percutaneous coronary intervention does not achieve effective myocardial reperfusion due to the occurrence of coronary microvascular obstruction (MVO). The amount of infarcted myocardium, the so-called infarct size, has long been known to be an independent predictor for major adverse cardiovascular events and adverse left ventricular remodeling after myocardial infarction. Previous cardioprotection studies were mainly aimed at protecting cardiomyocytes and reducing infarct size. However, several clinical and preclinical studies have reported that the presence and extent of MVO represent another important independent predictor of adverse left ventricular remodeling, and recent evidences support the notion that MVO may be more predictive of major adverse cardiovascular events than infarct size itself. Although timely and complete reperfusion is the most effective way of limiting myocardial injury and subsequent ventricular remodeling, the translation of effective therapeutic strategies into improved clinical outcomes has been largely disappointing. Of importance, despite the presence of a large number of studies focused on infarct size, only few cardioprotection studies addressed MVO as a therapeutic target. In this review, we provide a detailed summary of MVO including underlying causes, diagnostic techniques, and current therapeutic approaches. Furthermore, we discuss the hypothesis that simultaneously addressing infarct size and MVO may help to translate cardioprotective strategies into improved clinical outcome following ST-segment–elevation myocardial infarction.
Lingua originaleEnglish
pagine (da-a)245-258
Numero di pagine14
RivistaCirculation Research
Volume125
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • Adrenergic beta-Antagonists
  • Animals
  • Coronary Circulation
  • Fibrinolytic Agents
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Microcirculation
  • Myocardial infarction
  • Myocardial reperfusion
  • Myocardium
  • Percutaneous coronary intervention
  • ST Elevation Myocardial Infarction
  • Ventricular remodeling

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