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Update in pharmacological management of coronary no-reflow phenomenon.
MedLine Citation:
PMID:  22827250     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The no-reflow phenomenon (NRP) is defined as the lack of adequate myocardial tissue perfusion despite a patent epicardial coronary artery. The incidence of NRP varies between 2-5% of elective percutaneous coronary interventions (PCI) and 30% in primary PCI. Clinically, it is an independent predictor of myocardial infarction, in-hospital mortality, and long-term mortality. It may be categorized in interventional (after PCI, especially in saphenous venous grafts) or reperfusion NRP (after re-opening of a totally occluded coronary artery, usually during primary PCI or thrombolysis). There are many physiopathological factors implicated: distal microembolization, interstitial and intracellular edema, coronary spasm and capillary plugging. Although reperfusion and no reflow is a field of intense research, no single mechanical or pharmacological therapy has demonstrated a clear efficacy against NRP, probably due to its multifactorial nature. Once established, the treatment of NRP is based on vasodilators like adenosine, verapamil, nitroprusside or nicorandil. However, the efficacy of these measures is poor, so every effort should be made to prevent the apparition of NRP. The objective of this report is to provide an update of the pharmacological armamentarium available for the prevention and treatment of NRP, and suggest a systematic approach of the management of NRP according to the different possible clinical scenarios.
Authors:
Pablo Salinas; Santiago Jimenez-Valero; Raul Moreno; Angel Sanchez-Recalde; Guillermo Galeote; Luis Calvo; Juan Ruiz-Garcia; Sebastian Carrizo; Gabriel Trucco; Jose Lopez-Sendon
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular & hematological agents in medicinal chemistry     Volume:  10     ISSN:  1875-6182     ISO Abbreviation:  Cardiovasc Hematol Agents Med Chem     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-07-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101266881     Medline TA:  Cardiovasc Hematol Agents Med Chem     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  256-64     Citation Subset:  IM    
Affiliation:
Seccion de Hemodinamica, Servicio de Cardiologia, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. raulmorenog@terra.es.
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