The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection

Filippo Crea, Derek J Hausenloy, William Chilian, Sean M Davidson, Peter Ferdinandy, David Garcia-Dorado, Niels Van Royen, Rainer Schulz, Gerd Heusch

Risultato della ricerca: Contributo in rivistaArticolo in rivista

42 Citazioni (Scopus)

Abstract

The coronary circulation is both culprit and victim of acute myocardial infarction. The rupture of an epicardial atherosclerotic plaque with superimposed thrombosis causes coronary occlusion, and this occlusion must be removed to induce reperfusion. However, ischaemia and reperfusion cause damage not only in cardiomyocytes but also in the coronary circulation, including microembolization of debris and release of soluble factors from the culprit lesion, impairment of endothelial integrity with subsequently increased permeability and oedema formation, platelet activation and leucocyte adherence, erythrocyte stasis, a shift from vasodilation to vasoconstriction, and ultimately structural damage to the capillaries with eventual no-reflow, microvascular obstruction ( MVO), and intramyocardial haemorrhage ( IMH). Therefore, the coronary circulation is a valid target for cardioprotection, beyond protection of the cardiomyocyte. Virtually all of the above deleterious endpoints have been demonstrated to be favourably influenced by one or the other mechanical or pharmacological cardioprotective intervention. However, no-reflow is still a serious complication of reperfused myocardial infarction and carries, independently from infarct size, an unfavourable prognosis. MVO and IMH can be diagnosed by modern imaging technologies, but still await an effective therapy. The current review provides an overview of strategies to protect the coronary circulation from acute myocardial ischaemia/reperfusion injury. This article is part of a Cardiovascular Research Spotlight Issue entitled 'Cardioprotection Beyond the Cardiomyocyte', and emerged as part of the discussions of the European Union ( EU)-CARDIOPROTECTION Cooperation in Science and Technology ( COST) Action, CA16225.
Lingua originaleEnglish
pagine (da-a)1143-1155
Numero di pagine13
RivistaCardiovascular Research
Volume115
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • Cardioprotection
  • Coronary circulation
  • Ischaemia
  • Microvascular obstruction
  • Reperfusion

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