Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Issue 4 (9th November 2019)

• Record Type: Journal Article
• Authors: Konijnenberg, Lara S F; Damman, Peter; Duncker, Dirk J; Kloner, Robert A; Nijveldt, Robin; van Geuns, Robert-Jan M; Berry, Colin; Riksen, Niels P; Escaned, Javier; van Royen, Niels
• Is Part Of: Cardiovascular research. Volume 116:Issue 4(2020)
• Page Start: 787
• Page End: 805
• Publication Date: 2019-11-09
• Subjects: Coronary microvascular dysfunction -- ST-elevation myocardial infarction -- Microvascular reperfusion injury -- Intramyocardial haemorrhage -- Coronary microvascular endothelial cells; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Periodicals; 616.1
• DOI: 10.1093/cvr/cvz301
• Languages: English
• ISSNs: 0008-6363

Abstract

Abstract: Early mechanical reperfusion of the epicardial coronary artery by primary percutaneous coronary intervention (PCI) is the guideline-recommended treatment for ST-elevation myocardial infarction (STEMI). Successful restoration of epicardial coronary blood flow can be achieved in over 95% of PCI procedures. However, despite angiographically complete epicardial coronary artery patency, in about half of the patients perfusion to the distal coronary microvasculature is not fully restored, which is associated with increased morbidity and mortality. The exact pathophysiological mechanism of post-ischaemic coronary microvascular dysfunction (CMD) is still debated. Therefore, the current review discusses invasive and non-invasive techniques for the diagnosis and quantification of CMD in STEMI in the clinical setting as well as results from experimental in vitro and in vivo models focusing on ischaemic-, reperfusion-, and inflammatory damage to the coronary microvascular endothelial cells. Finally, we discuss future opportunities to prevent or treat CMD in STEMI patients. Graphical Abstract: