Microvascular Obstruction in ST-Segment Elevation Myocardial Infarction: Looking Back to Move Forward. Focus on CMR.
Cesar Rios-NavarroVictor Marcos-GarcesAntoni Bayes-GenisOliver HusserJulio NunezVicente BodiPublished in: Journal of clinical medicine (2019)
After a myocardial infarction (MI), despite the resolution of the coronary occlusion, the deterioration of myocardial perfusion persists in a considerable number of patients. This phenomenon is known as microvascular obstruction (MVO). Initially, the focus was placed on re-establishing blood flow in the epicardial artery. Then, the observation that MVO has profound negative structural and prognostic repercussions revived interest in microcirculation. In the near future, the availability of co-adjuvant therapies (beyond timely coronary reperfusion) aimed at preventing, minimizing, and repairing MVOs and finding convincing answers to questions regarding what, when, how, and where to administer these therapies will be of utmost importance. The objective of this work is to review the state-of-the-art concepts on pathophysiology, diagnostic methods, and structural and clinical implications of MVOs in patients with ST-segment elevation MIs. Based on this knowledge we discuss previously-tested and future opportunities for the prevention and repair of MVO.
Keyphrases
- blood flow
- st segment elevation myocardial infarction
- percutaneous coronary intervention
- coronary artery disease
- coronary artery
- end stage renal disease
- ejection fraction
- current status
- newly diagnosed
- chronic kidney disease
- healthcare
- acute myocardial infarction
- early stage
- aortic stenosis
- peritoneal dialysis
- acute coronary syndrome
- single molecule
- atrial fibrillation
- autism spectrum disorder