title: The no-reflow phenomenon: State of the art.
abstract: Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI), with nearly 95% of occluded coronary vessels being reopened in this setting. Despite re-establishing epicardial coronary vessel patency, primary PCI may fail to restore optimal myocardial reperfusion within the myocardial tissue, a failure at the microvascular level known as no-reflow (NR). NR has been reported to occur in up to 60% of STEMI patients with optimal coronary vessel reperfusion. When it does occur, it significantly attenuates the beneficial effect of reperfusion therapy, leading to poor outcomes. The pathophysiology of NR is complex and incompletely understood. Many phenomena are known to contribute to NR, including leukocyte infiltration, vasoconstriction, activation of inflammatory pathways and cellular oedema. Vascular damage and haemorrhage may also play important roles in the establishment of NR. In this review, we describe the pathophysiological mechanisms of NR and the tools available for diagnosing it. We also describe the microvasculature and the endothelial mechanisms involved in NR, which may provide relevant therapeutic targets for reducing NR and improving the prognosis for patients.
authors.affiliation: Service de cardiologie, hôpital Bichat, AP-HP, Paris, France; DHU FIRE, université Paris Diderot, Paris, France; Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouleti
authors.affiliation: Hôpital cardiovasculaire Louis-Pradel, centre d'investigation clinique unité, hospices civils de Lyon, Bron, France; Inserm U 1407, Lyon, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.affiliation: Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France. Electronic address: stephane.germain@college-de-france.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Germain
mesh_terms: D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000503:physiopathology* / Q000601:surgery; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D054318:No-Reflow Phenomenon / Q000150:complications / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis
keywords: Angioplastie coronaire primaire; Infarctus du myocarde; Ischaemia; Ischémie; No-reflow; Perméabilité vasculaire; Primary coronary angioplasty; Reperfusion; Vascular permeability