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
-
Chemokine Contribution in Stem Cell Engraftment into the Infarcted Myocardium
Current Stem Cell Research & Therapy Human Tissue Kallikrein: A New Bullet for the Treatment of Ischemia
Current Pharmaceutical Design Mitochondrial Metabolism Modulation: A New Therapeutic Approach for Parkinsons Disease
CNS & Neurological Disorders - Drug Targets Oxidative Stress in Traumatic Brain Injury
Current Medicinal Chemistry Biomarkers of Acute Kidney Injury in Critical Care Medicine: A Literature Review Based on Recent Patent Applications
Recent Patents on Biomarkers Scutellarin Attenuates Microglia-Mediated Neuroinflammation and Promotes Astrogliosis in Cerebral Ischemia - A Therapeutic Consideration
Current Medicinal Chemistry The Glutathione System and its Regulation by Neurohormone Melatonin in the Central Nervous System
Central Nervous System Agents in Medicinal Chemistry Nitric Oxide and its Antithrombotic Action in the Cardiovascular System
Current Drug Targets - Cardiovascular & Hematological Disorders Editorial: [Hot Topic: Recent Developments in Biomarker Patenting for AKI]
Recent Patents on Biomarkers Pharmacodynamics of Memantine: An Update
Current Neuropharmacology Neuroprotection by Diazoxide in Animal Models for Cerebrovascular Disorders
Vascular Disease Prevention (Discontinued) Cytochromes P450 in the Bioactivation of Chemicals
Current Topics in Medicinal Chemistry Tetrahydrobiopterin Biosynthesis, Utilization and Pharmacological Effects
Current Drug Metabolism COVID-19: A Great Mime or a Trigger Event of Autoimmune Manifestations?
Current Rheumatology Reviews Herbal and Traditional Chinese Medicine for the Treatment of Cardiovascular Complications in Diabetes Mellitus
Current Diabetes Reviews Genetic Variations of the Hemostatic System as Risk Factors for Venous and Arterial Thrombotic Disease
Current Genomics Can Targeting the Incretin Pathway Dampen RAGE-Mediated Events in Diabetic Nephropathy?
Current Drug Targets Nox Inhibitors & Therapies: Rational Design of Peptidic and Small Molecule Inhibitors
Current Pharmaceutical Design Pulmonary Hypertension: Clinical Presentation, Diagnosis, Treatment,and Dana Point World Symposium Highlights
Current Respiratory Medicine Reviews Chemical Constituents of Plants from the Genus Forsythia
Mini-Reviews in Organic Chemistry