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Optimized Treatment of ST-Elevation Myocardial Infarction The Unmet Need to Target Coronary Microvascular Obstruction as Primary Treatment Goal to Further Improve Prognosis

Niccoli, G; Montone, RA; Ibanez, B; Thiele, H; Crea, F; Heusch, G; Bulluck, H; ... Eitel, I; + view all (2019) Optimized Treatment of ST-Elevation Myocardial Infarction The Unmet Need to Target Coronary Microvascular Obstruction as Primary Treatment Goal to Further Improve Prognosis. Circulation Research , 125 (2) pp. 245-258. 10.1161/CIRCRESAHA.119.315344.

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Abstract

Primary percutaneous coronary intervention is nowadays the preferred reperfusion strategy for patients with acute ST-segment–elevation myocardial infarction, aiming at restoring epicardial infarct-related artery patency and achieving microvascular reperfusion as early as possible, thus limiting the extent of irreversibly injured myocardium. Yet, in a sizeable proportion of patients, primary percutaneous coronary intervention does not achieve effective myocardial reperfusion due to the occurrence of coronary microvascular obstruction (MVO). The amount of infarcted myocardium, the so-called infarct size, has long been known to be an independent predictor for major adverse cardiovascular events and adverse left ventricular remodeling after myocardial infarction. Previous cardioprotection studies were mainly aimed at protecting cardiomyocytes and reducing infarct size. However, several clinical and preclinical studies have reported that the presence and extent of MVO represent another important independent predictor of adverse left ventricular remodeling, and recent evidences support the notion that MVO may be more predictive of major adverse cardiovascular events than infarct size itself. Although timely and complete reperfusion is the most effective way of limiting myocardial injury and subsequent ventricular remodeling, the translation of effective therapeutic strategies into improved clinical outcomes has been largely disappointing. Of importance, despite the presence of a large number of studies focused on infarct size, only few cardioprotection studies addressed MVO as a therapeutic target. In this review, we provide a detailed summary of MVO including underlying causes, diagnostic techniques, and current therapeutic approaches. Furthermore, we discuss the hypothesis that simultaneously addressing infarct size and MVO may help to translate cardioprotective strategies into improved clinical outcome following ST-segment–elevation myocardial infarction.

Type: Article
Title: Optimized Treatment of ST-Elevation Myocardial Infarction The Unmet Need to Target Coronary Microvascular Obstruction as Primary Treatment Goal to Further Improve Prognosis
DOI: 10.1161/CIRCRESAHA.119.315344
Publisher version: https://doi.org/10.1161/CIRCRESAHA.119.315344
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: myocardial infarction, myocardial reperfusion, myocardium, percutaneous coronary intervention, ventricular remodeling
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: https://discovery.ucl.ac.uk/id/eprint/10079321
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