Document Detail

Myocardial no-reflow in humans.
MedLine Citation:
PMID:  19608025     Owner:  NLM     Status:  MEDLINE    
In a variable proportion of patients presenting with ST-segment elevation myocardial infarction, ranging from 5% to 50%, primary percutaneous coronary intervention achieves epicardial coronary artery reperfusion but not myocardial reperfusion, a condition known as no-reflow. Of note, no-reflow is associated with a worse prognosis at follow-up. The phenomenon has a multifactorial pathogenesis including: distal embolization, ischemia-reperfusion injury, and individual predisposition of coronary microcirculation to injury. Moreover, it is spontaneously reversible in some patients, thus suggesting that it might be amenable to treatment also when we fail to prevent it. Several recent studies have shown that biomarkers and other easily available clinical parameters can predict the risk of no-reflow and can help in the assessment of the multiple mechanisms of the phenomenon. Several therapeutic strategies have been tested for the prevention and treatment of no-reflow. In particular, thrombus aspiration before stent implantation prevents distal embolization and has been recently shown to improve myocardial perfusion and clinical outcome as compared with the standard procedure. However, it is conceivable that the relevance of each pathogenetic component of no-reflow is different in different patients, thus explaining the occurrence of no-reflow despite the use of mechanical thrombus aspiration. Thus, in this review article, for the first time, we propose a personalized management of no-reflow on the basis of the assessment of the prevailing mechanisms of no-reflow operating in each patient.
Giampaolo Niccoli; Francesco Burzotta; Leonarda Galiuto; Filippo Crea
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-17     Completed Date:  2009-08-31     Revised Date:  2010-02-04    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  281-92     Citation Subset:  AIM; IM    
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Circulation
Myocardial Infarction / physiopathology,  therapy*
Myocardial Reperfusion*
Myocardial Reperfusion Injury / physiopathology*
Myocardial Revascularization*
Comment In:
J Am Coll Cardiol. 2009 Dec 8;54(24):2340-1; author reply 2341   [PMID:  19958978 ]
J Am Coll Cardiol. 2010 Jan 19;55(3):264-5; author reply 265   [PMID:  20117420 ]

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