title: Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction.
abstract: After successful primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, adequate myocardial reperfusion is not achieved in up to 50% of patients. This phenomenon of no-reflow is associated with a poor in-hospital and long-term prognosis. Four main factors are thought to contribute to the occurrence of no-reflow: ischaemic injury; reperfusion injury; distal embolization; susceptibility of the microcirculation to injury. This review evaluates the literature, and in particular the clinical trials, concerned with pharmacological and physical methods for prevention and treatment of no-reflow. A number of drugs may improve no-reflow experimentally and clinically, but some have not yet been associated with conclusive improvements in clinical outcome. The complex interacting factors in no-reflow make it unlikely that any single agent will be effective for all patients. Confirmed methods known to be beneficial in the prevention of no-reflow (such as aspirin therapy, chronic statin therapy, blood glucose control, thrombus aspiration in patients with a high thrombus burden and ischaemic preconditioning) should be offered to patients as often as possible, to prevent and treat no-reflow.
authors: Department of Geriatric Nephrology, Institute of Gerontology, Chinese PLA General Hospital, Beijing 100853, China.
authors: Ao Qiang
authors: AQ
authors: Guo
authors: Lei
authors: L
authors: Sheng
authors: Xu
authors: X
authors: Lei
authors: Wang
authors: W
authors: Shu
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019468:Disease Management; D004618:Embolism, Air / Q000517:prevention & control; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015425:Myocardial Reperfusion; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D054318:No-Reflow Phenomenon / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D002316:Cardiotonic Agents; D005343:Fibrinolytic Agents; D014665:Vasodilator Agents
keywords: No-reflow; ST-segment elevation myocardial infarction; prevention; primary percutaneous coronary intervention; treatment