title: Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand?
abstract: For patients presenting with an acute ST-segment-elevation myocardial infarction, the most effective therapy for reducing myocardial infarct size and preserving left ventricular systolic function is primary percutaneous coronary intervention (PPCI). However, mortality and morbidity remain significant. This is partly attributed to the development of microvascular obstruction, which occurs in around 50% of ST-segment-elevation myocardial infarction patients post-PPCI, and it is associated with adverse left ventricular remodeling and worse clinical outcomes. Although microvascular obstruction can be detected by cardiac imaging techniques several hours post-PPCI, it may be too late to intervene at that time. Therefore, being able to predict the development of microvascular obstruction at the time of PPCI may identify high-risk patients who might benefit from further adjuvant intracoronary therapies, such as thrombolysis, vasodilators, glycoprotein IIb/IIIa inhibitors, and anti-inflammatory agents that may reduce microvascular obstruction. Recent studies have shown that invasive coronary physiology measurements performed during PPCI can be used to assess the coronary microcirculation. In this article, we provide an overview of the various invasive methods currently available to assess the coronary microcirculation in the setting of ST-segment-elevation myocardial infarction, and how they could potentially be used in the future for tailoring therapies to those most at risk.
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
authors.forename: Jack W
authors.initials: JW
authors.lastname: Tan
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Low
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
authors.forename: Murat
authors.initials: M
authors.lastname: Sezer
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.). derek.hausenloy@duke-nus.edu.sg.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008833:Microcirculation; D054318:No-Reflow Phenomenon / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014655:Vascular Resistance
keywords: adenosine; endothelial cells; microcirculation; myocardial infarction; no-reflow phenomenon; percutaneous coronary intervention