Document Detail

Prevention and treatment of no-reflow.
MedLine Citation:
PMID:  20698732     Owner:  NLM     Status:  MEDLINE    
No-reflow phenomenon occurs frequently during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction and it has a strong negative impact on outcome. Prevention of no-reflow has to be defined as any attempt to prevent its occurrence prior to or during the recanalization procedure. Strategy of prevention may be pharmacological or device based. Among drugs, abciximab is indicated by European Society of Cardiology (ESC) guidelines for prevention of no-reflow (class of recommendation IIa and level of evidence B). Among devices used for preventing no-reflow, manual thrombus aspiration only has been associated with a reduction of no-reflow and lower mortality at follow-up and is currently indicated in the ESC guidelines (class IIa of recommendation and level B of evidence). Treatment of no-reflow has to be defined as any attempt to treat its occurrence after coronary recanalization. Strategy of treatment may be pharmacological or device based. Adenosine and verapamil are indicated by ESC guidelines for treatment of no-reflow (class of recommendation IIb and level of evidence B and C, respectively). Serial assessment of myocardial perfusion showed that in up to 50% of patients no-reflow is spontaneously reversible. This finding may open new scenarios, as mechanisms of reversibility may become future therapeutic targets.
Giampaolo Niccoli; Marcello Marino; Cristina Spaziani; Filippo Crea
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Acute cardiac care     Volume:  12     ISSN:  1748-295X     ISO Abbreviation:  Acute Card Care     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-02     Completed Date:  2010-11-04     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  101276603     Medline TA:  Acute Card Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  81-91     Citation Subset:  IM    
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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MeSH Terms
Adenosine / pharmacology,  therapeutic use
Angioplasty, Balloon, Coronary / adverse effects
Antibodies, Monoclonal / pharmacology,  therapeutic use
Immunoglobulin Fab Fragments / pharmacology,  therapeutic use
Myocardial Infarction / physiopathology,  therapy*
Myocardial Reperfusion / adverse effects*,  methods
No-Reflow Phenomenon / diagnosis,  drug therapy*,  etiology,  prevention & control*,  surgery*
Treatment Outcome
Verapamil / pharmacology,  therapeutic use
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 52-53-9/Verapamil; 58-61-7/Adenosine; X85G7936GV/abciximab

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