title: Coronary microvascular obstruction in acute myocardial infarction.
abstract: The success of a primary percutaneous intervention (PCI) in the setting of ST elevation myocardial infarction depends on the functional and structural integrity of coronary microcirculation. Coronary microvascular dysfunction and obstruction (CMVO) occurs in up to half of patients submitted to apparently successful primary PCI and is associated to a much worse outcome. The current review summarizes the complex mechanisms responsible for CMVO, including pre-existing coronary microvascular dysfunction, and highlights the current limitations in the assessment of microvascular function. More importantly, at the light of the substantial failure of trials hitherto published on the treatment of CMVO, this review proposes a novel integrated therapeutic approach, which should overcome the limitations of previous studies.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy gniccoli73@hotmail.it.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.affiliation: Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004195:Disease Models, Animal; D004198:Disease Susceptibility / Q000150:complications; D004359:Drug Therapy, Combination; D004617:Embolism / Q000209:etiology / Q000503:physiopathology; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008833:Microcirculation / Q000502:physiology; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011188:Potassium / Q000627:therapeutic use; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology* / Q000628:therapy; D013552:Swine
chemical_list: D007328:Insulin; D010975:Platelet Aggregation Inhibitors; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium
keywords: Acute myocardial infarction; Microvascular dysfunction; Microvascular obstruction