Microvascular Obstruction in Acute Myocardial Infarction, a Potential Therapeutic Target.
Mina S A GhobrialBilal BawamiaTimothy CartlidgeIoakim SpyridopoulosVijay KunadianAzfar G ZamanMohaned EgredAdam McDiarmidMatthew G L WilliamsMohamed FaragMohammad AlkhalilPublished in: Journal of clinical medicine (2023)
Microvascular obstruction (MVO) is a recognised phenomenon following mechanical reperfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI). Invasive and non-invasive modalities to detect and measure the extent of MVO vary in their accuracy, suggesting that this phenomenon may reflect a spectrum of pathophysiological changes at the level of coronary microcirculation. The importance of detecting MVO lies in the observation that its presence adds incremental risk to patients following STEMI treatment. This increased risk is associated with adverse cardiac remodelling seen on cardiac imaging, increased infarct size, and worse patient outcomes. This review provides an outline of the pathophysiology, clinical implications, and prognosis of MVO in STEMI. It describes historic and novel pharmacological and non-pharmacological therapies to address this phenomenon in conjunction with primary PCI.
Keyphrases
- percutaneous coronary intervention
- st segment elevation myocardial infarction
- acute myocardial infarction
- coronary artery disease
- st elevation myocardial infarction
- acute coronary syndrome
- antiplatelet therapy
- coronary artery bypass grafting
- left ventricular
- end stage renal disease
- atrial fibrillation
- ejection fraction
- coronary artery bypass
- coronary artery
- chronic kidney disease
- newly diagnosed
- peritoneal dialysis
- high resolution
- heart failure
- emergency department
- blood brain barrier
- mass spectrometry
- climate change
- acute ischemic stroke
- patient reported outcomes
- aortic valve