Abstract
Despite achievement of optimal epicardial coronary flow in the majority of patients treated for ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), myocardial no-reflow is a common phenomenon occurring in 5 to 50% of patients. The no-reflow phenomenon is a predictor of infarct size and an independent predictor of mortality both in the short and long term. Prevention of no-reflow is therefore a crucial step in improving prognosis of patients with STEMI. Several strategies including pharmacological and mechanical ones have been developed to improve microvascular perfusion in the setting of a myocardial infarction. Prevention starts by conservation of the microvascular reserve especially in patients at high risk of acute coronary syndromes such as diabetes patients. Optimal glycaemic control and the use of statins have been shown to reduce no-reflow in this context. Reducing ischaemic time by shortening door to balloon times, administration of intracoronary GP IIb/IIIa antagonists during PPCI and the use of manual aspiration thrombectomy have been shown to result in better myocardial perfusion and improved clinical outcome in major trials. In this review we discuss some of these major trials and studies of other therapeutic options that aim to prevent the no-reflow phenomenon.
Keywords: Myocardial infarction, no-reflow phenomenon, microcirculation, infarct size, pharmacological prevention, mechanical prevention
Current Vascular Pharmacology
Title:Myocardial ‘No-Reflow’ Prevention
Volume: 11 Issue: 2
Author(s): Michael Magro, Tirza Springeling, Robert Jan van Geuns and Felix Zijlstra
Affiliation:
Keywords: Myocardial infarction, no-reflow phenomenon, microcirculation, infarct size, pharmacological prevention, mechanical prevention
Abstract: Despite achievement of optimal epicardial coronary flow in the majority of patients treated for ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), myocardial no-reflow is a common phenomenon occurring in 5 to 50% of patients. The no-reflow phenomenon is a predictor of infarct size and an independent predictor of mortality both in the short and long term. Prevention of no-reflow is therefore a crucial step in improving prognosis of patients with STEMI. Several strategies including pharmacological and mechanical ones have been developed to improve microvascular perfusion in the setting of a myocardial infarction. Prevention starts by conservation of the microvascular reserve especially in patients at high risk of acute coronary syndromes such as diabetes patients. Optimal glycaemic control and the use of statins have been shown to reduce no-reflow in this context. Reducing ischaemic time by shortening door to balloon times, administration of intracoronary GP IIb/IIIa antagonists during PPCI and the use of manual aspiration thrombectomy have been shown to result in better myocardial perfusion and improved clinical outcome in major trials. In this review we discuss some of these major trials and studies of other therapeutic options that aim to prevent the no-reflow phenomenon.
Export Options
About this article
Cite this article as:
Magro Michael, Springeling Tirza, Jan van Geuns Robert and Zijlstra Felix, Myocardial ‘No-Reflow’ Prevention, Current Vascular Pharmacology 2013; 11 (2) . https://dx.doi.org/10.2174/1570161111311020014
DOI https://dx.doi.org/10.2174/1570161111311020014 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
Ischemic Cardiovascular Diseases: Mechanisms, Diagnosis and Therapy
Ischemic cardiovascular disease includes myocardial infarction, coronary atherosclerotic heart disease, angina pectoris, etc., constitute the leading cause of patient mortality by preventing tissues from getting sufficient oxygen and nutrients. Ischemic heart disease, as a clinical condition, is characterized by myocardial ischemia, causing an imbalance between myocardial blood supply and demand, ...read more
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
-
The Role of Obesity in Cardiomyopathy and Nephropathy
Current Pharmaceutical Design The Injured Cochlea as a Target for Inflammatory Processes, Initiation of Cell Death Pathways and Application of Related Otoprotective Strategies
Recent Patents on CNS Drug Discovery (Discontinued) Ex Vivo Liver – Directed Gene Therapy for the Treatment of Metabolic Diseases: Advances in Hepatocyte Transplantation and Retroviral Vectors
Current Gene Therapy The Role of Fatty Acids in the Regulation of Cerebral Vascular Function and Neuroprotection in Ischemia
CNS & Neurological Disorders - Drug Targets An Overview of Recent Patents on Nanoparticles for Drug Delivery Across the Blood Brain Barrier
Recent Patents on Nanomedicine Chronic Inflammatory Diseases and the Acute Respiratory Distress Syndrome (ARDS)
Current Pharmaceutical Design Reducing the Risk of Major Elective Non-cardiac Surgery: Is there a Role for Levosimendan in the Preoperative Optimization of Cardiac Function?
Current Drug Targets Association of Oxidative Stress to the Genesis of Anxiety: Implications for Possible Therapeutic Interventions
Current Neuropharmacology The Role of Intracellular 35-Cyclic Adenosine Monophosphate (cAMP) in Atherosclerosis
Current Vascular Pharmacology Long Chain n-3 Polyunsaturated Fatty Acids in the Prevention of Allergic and Cardiovascular Disease
Current Pharmaceutical Design Mitochondria-Targeted Antioxidants as a Therapeutic Strategy for Protecting Endothelium in Cardiovascular Diseases
Current Medicinal Chemistry Impaired Expression and Function of Cancer-Related Enzymes by Anthocyans: An Update
Current Enzyme Inhibition Neuroprotection for Ischemic Injury in the Immature Brain
Current Pediatric Reviews Radial Approach for Percutaneous Coronary Intervention
Reviews on Recent Clinical Trials Molecular Recognition Mechanisms for Detecting Cell Death In Vivo
Current Pharmaceutical Biotechnology Molecular Pharmacology of the Glycine Receptor Chloride Channel
Current Pharmaceutical Design Out-of-Hospital Cardiac Arrest –Optimal Management
Current Cardiology Reviews Microbiota-Immune System Interactions in Human Neurological Disorders
CNS & Neurological Disorders - Drug Targets Mechanisms of Endogenous Endothelial Repair in Stroke
Current Pharmaceutical Design The Role of MIF in Hepatic Function, Oxidative Stress, and Inflammation in Thioacetamide-induced Liver Injury in Mice: Protective Effects of Betaine
Current Medicinal Chemistry