Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 141 No. 4950 (2011)

Optimal reperfusion in ST-elevation myocardial infarction – the role of the coronary microcirculation

  • Caterina De
  • RK Kharbanda
  • AP Banning
DOI
https://doi.org/10.4414/smw.2011.13313
Cite this as:
Swiss Med Wkly. 2011;141:w13313
Published
05.12.2011

Summary

Coronary microcirculation plays a crucial role for the outcomes of patients with STEMI. Although PPCI improves outcomes compared to thrombolysis, a substantial amount of STEMI patients do not achieve optimal myocardial reperfusion. Angiographic methods for assessment of reperfusion like TIMI Flow and MBG are easy to use but new, catheter laboratory based techniques to assess reperfusion have a lot of potential to assess and potentially guide management of patients with STEMI.

References

  1. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–45.
  2. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31(20):2501–55.
  3. Stolt Steiger V, Goy JJ, Stauffer JC, Radovanovic D, Duvoisin N, Urban P, et al. Significant decrease in in-hospital mortality and major adverse cardiac events in Swiss STEMI patients between 2000 and December 2007. Swiss Med Wkly. 2009;139(31-32):453–7.
  4. Ndrepepa G, Tiroch K, Keta D, Fusaro M, Seyfarth M, Pache J, et al. Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ Cardiovasc Interv. 2010;3(1):27–33.
  5. Ahumada G, Roberts R, Sobel BE. Evaluation of myocardial infarction with enzymatic indices. Prog Cardiovasc Dis. 1976;18(5):405–20.
  6. Twerenbold R, Reichlin T, Reiter M, Muller C. High-sensitive cardiac troponin: friend or foe? Swiss Med Wkly. 2011;141:w13202.
  7. Hallen J, Buser P, Schwitter J, Petzelbauer P, Geudelin B, Fagerland MW, et al. Relation of cardiac troponin I measurements at 24 and 48 hours to magnetic resonance-determined infarct size in patients with ST-elevation myocardial infarction. Am J Cardiol. 2009;104(11):1472–7.
  8. Younger JF, Plein S, Barth J, Ridgway JP, Ball SG, Greenwood JP. Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction. Heart. 2007;93(12):1547–51.
  9. Katan M, Christ-Crain M. The stress hormone copeptin: a new prognostic biomarker in acute illness. Swiss Med Wkly. 2010;140:w13101.
  10. Schwartz BG, Kloner RA. Coronary no reflow. J Mol Cell Cardiol. 2011.
  11. van ’t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998;97(23):2302–6.
  12. Kloner RA, Ganote CE, Jennings RB. The “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Invest. 1974;54(6):1496–508.
  13. Ambrosio G, Weisman HF, Mannisi JA, Becker LC. Progressive impairment of regional myocardial perfusion after initial restoration of postischemic blood flow. Circulation. 1989;80(6):1846–61.
  14. Przyklenk K, Kloner RA. “Reperfusion injury” by oxygen-derived free radicals? Effect of superoxide dismutase plus catalase, given at the time of reperfusion, on myocardial infarct size, contractile function, coronary microvasculature, and regional myocardial blood flow. Circ Res. 1989;64(1):86–96.
  15. Kleinbongard P, Bose D, Baars T, Mohlenkamp S, Konorza T, Schoner S, et al. Vasoconstrictor potential of coronary aspirate from patients undergoing stenting of saphenous vein aortocoronary bypass grafts and its pharmacological attenuation. Circ Res. 2011;108(3):344–52.
  16. Schroder R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation. 2004;110(21):e506–510.
  17. De Luca G, Maas AC, Suryapranata H, Ottervanger JP, Hoorntje JC, Gosselink AT, et al. Prognostic significance of residual cumulative ST-segment deviation after mechanical reperfusion in patients with ST-segment elevation myocardial infarction. Am Heart J. 2005;150(6):1248–54.
  18. Francois SJ, Erne P, Urban P, Maggiorini M, Seifert B, Gutzwiller F, Radovanovic D. Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008. Swiss Med Wkly. 2010;140:w13078.
  19. Hayat SA, Senior R. Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Eur Heart J. 2008;29(3):299–314.
  20. Galiuto L, Garramone B, Scara A, Rebuzzi AG, Crea F, La Torre G, et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling: results of the multicenter AMICI study. J Am Coll Cardiol. 2008;51(5):552–9.
  21. Streb W, Marciniak M, Claus P, Marciniak A, McLaughlin M, D’Hooge J, et al. Full or pressure limited reperfusion of an acute myocardial infarct results in a different wall thickness and deformation of the distal myocardium – implications for clinical reperfusion strategies. Eur J Echocardiogr. 2008;9(4):458–65.
  22. Turschner O, D’Hooge J, Dommke C, Claus P, Verbeken E, De Scheerder I, et al. The sequential changes in myocardial thickness and thickening which occur during acute transmural infarction, infarct reperfusion and the resultant expression of reperfusion injury. Eur Heart J. 2004;25(9):794–803.
  23. Beek AM, van Rossum AC. Cardiovascular magnetic resonance imaging in patients with acute myocardial infarction. Heart. 2010;96(3):237–43.
  24. Vicente J, Mewton N, Croisille P, Staat P, Bonnefoy-Cudraz E, Ovize M, Revel D. Comparison of the angiographic myocardial blush grade with delayed-enhanced cardiac magnetic resonance for the assessment of microvascular obstruction in acute myocardial infarctions. Catheter Cardiovasc Interv. 2009;74(7):1000–7.
  25. Nijveldt R, Beek AM, Hirsch A, Stoel MG, Hofman MB, Umans VA, et al. Functional recovery after acute myocardial infarction: comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury. J Am Coll Cardiol. 2008;52(3):181–9.
  26. Driesen RB, Zalewski J, Driessche NV, Vermeulen K, Bogaert J, Sipido KR, et al. Histological correlate of a cardiac magnetic resonance imaged microvascular obstruction in a porcine model of ischemia-reperfusion. Cardiovasc Pathol. 2011.
  27. Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97(8):765–72.
  28. Bekkers SC, Yazdani SK, Virmani R, Waltenberger J. Microvascular obstruction: underlying pathophysiology and clinical diagnosis. J Am Coll Cardiol. 2010;55(16):1649–60.
  29. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987;76(1):142–54.
  30. Anabitarte P, Kurz DJ, Stettler I, Naegeli B, Bertel O, Frielingsdorf J, et al. Long-term survival and functional outcome of unselected patients undergoing percutaneous coronary intervention for acute myocardial infarction. Swiss Med Wkly. 2009;139(43-44):636–41.
  31. Gibson CM, Cannon CP, Daley WL, Dodge JT, Jr., Alexander B, Jr., Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879–88.
  32. Lepper W, Hoffmann R, Kamp O, Franke A, de Cock CC, Kuhl HP, et al. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angioplasty [correction of angiography] in patients with acute myocardial infarction. Circulation. 2000;101(20):2368–74.
  33. Fearon WF, Farouque HM, Balsam LB, Caffarelli AD, Cooke DT, Robbins RC, et al. Comparison of coronary thermodilution and Doppler velocity for assessing coronary flow reserve. Circulation. 2003;108(18):2198–200.
  34. Cuculi F, De Caterina AR, Banning AP. Large perfusion defect on scintigraphy explained by severe microcirculatory dysfunction. J Invasive Cardiol. 2011;23(10):E247–248.
  35. Fearon WF, Balsam LB, Farouque HM, Caffarelli AD, Robbins RC, Fitzgerald PJ, et al. Novel index for invasively assessing the coronary microcirculation. Circulation. 2003;107(25):3129–32.
  36. Fearon WF, Shah M, Ng M, Brinton T, Wilson A, Tremmel JA, et al. Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2008;51(5):560–5.
  37. Lim HS, Yoon MH, Tahk SJ, Yang HM, Choi BJ, Choi SY, et al. Usefulness of the index of microcirculatory resistance for invasively assessing myocardial viability immediately after primary angioplasty for anterior myocardial infarction. Eur Heart J. 2009;30(23):2854–60.
  38. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54(4):281–92.
  39. McLaughlin MG, Stone GW, Aymong E, Gardner G, Mehran R, Lansky AJ, et al. Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. J Am Coll Cardiol. 2004;44(6):1215–23.
  40. Cuculi F, Lim CC, Banning AP. Periprocedural myocardial injury during elective percutaneous coronary intervention: is it important and how can it be prevented? Heart. 96(10):736–40.
  41. Selvanayagam JB, Porto I, Channon K, Petersen SE, Francis JM, Neubauer S, et al. Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation. 2005;111(8):1027–32.
  42. Porto I, Selvanayagam JB, Van Gaal WJ, Prati F, Cheng A, Channon K, et al. Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonance imaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation. 2006;114(7):662–9.
  43. Selvanayagam JB, Cheng AS, Jerosch-Herold M, Rahimi K, Porto I, van Gaal W, et al. Effect of distal embolization on myocardial perfusion reserve after percutaneous coronary intervention: a quantitative magnetic resonance perfusion study. Circulation. 2007;116(13):1458–64.
  44. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1999;341(26):1949–56.
  45. Costantini CO, Stone GW, Mehran R, Aymong E, Grines CL, Cox DA, et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction. J Am Coll Cardiol. 2004;44(2):305–12.
  46. Bavry AA, Kumbhani DJ, Bhatt DL. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur Heart J. 2008;29(24):2989–3001.
  47. De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J. 2008;29(24):3002–10.
  48. Prati F, Petronio S, Van Boven AJ, Tendera M, De Luca L, de Belder MA, et al. Evaluation of infarct-related coronary artery patency and microcirculatory function after facilitated percutaneous primary coronary angioplasty: the FINESSE-ANGIO (Facilitated Intervention With Enhanced Reperfusion Speed to Stop Events-Angiographic) study. JACC Cardiovasc Interv. 2010;3(12):1284–91.
  49. Mehilli J, Kastrati A, Schulz S, Frungel S, Nekolla SG, Moshage W, et al. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial. Circulation. 2009;119(14):1933–40.
  50. De Luca G, Gibson CM, Bellandi F, Murphy S, Maioli M, Noc M, et al. Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis. Heart. 2008;94(12):1548–58.
  51. Labinaz M, Ho C, Banerjee S, Martin J, Chen S, Mensinkai S. Meta-analysis of clinical efficacy and bleeding risk with intravenous glycoprotein IIb/IIIa antagonists for percutaneous coronary intervention. Can J Cardiol. 2007;23(12):963–70.
  52. De Luca G, Navarese E, Marino P. Risk profile and benefits from Gp IIb-IIIa inhibitors among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-regression analysis of randomized trials. Eur Heart J. 2009;30(22):2705–13.
  53. Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008;358(21):2218–30.
  54. Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, et al. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial. Lancet. 2009;374(9696):1149–59.
  55. Flammer AJ, Luscher TF. Three decades of endothelium research: from the detection of nitric oxide to the everyday implementation of endothelial function measurements in cardiovascular diseases. Swiss Med Wkly. 2010;140:w13122.
  56. Russo I, Doronzo G, Mattiello L, De Salve A, Trovati M, Anfossi G. The activity of constitutive nitric oxide synthase is increased by the pathway cAMP/cAMP-activated protein kinase in human platelets. New insights into the antiaggregating effects of cAMP-elevating agents. Thromb Res. 2004;114(4):265–73.
  57. Cronstein BN, Rosenstein ED, Kramer SB, Weissmann G, Hirschhorn R. Adenosine; a physiologic modulator of superoxide anion generation by human neutrophils. Adenosine acts via an A2 receptor on human neutrophils. J Immunol. 1985;135(2):1366–71.
  58. Ely SW, Berne RM. Protective effects of adenosine in myocardial ischemia. Circulation. 1992;85(3):893–904.
  59. Jordan JE, Zhao ZQ, Sato H, Taft S, Vinten-Johansen J. Adenosine A2 receptor activation attenuates reperfusion injury by inhibiting neutrophil accumulation, superoxide generation and coronary endothelial adherence. J Pharmacol Exp Ther. 1997;280(1):301–9.
  60. Marzilli M, Orsini E, Marraccini P, Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000;101(18):2154–9.
  61. Desmet W, Bogaert J, Dubois C, Sinnaeve P, Adriaenssens T, Pappas C, et al. High-dose intracoronary adenosine for myocardial salvage in patients with acute ST-segment elevation myocardial infarction. Eur Heart J. 2011;32(7):867–77.
  62. Parham WA, Bouhasin A, Ciaramita JP, Khoukaz S, Herrmann SC, Kern MJ. Coronary hyperemic dose responses of intracoronary sodium nitroprusside. Circulation. 2004;109(10):1236–43.
  63. Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, et al. Incidence and treatment of “no-reflow” after percutaneous coronary intervention. Circulation. 1994;89(6):2514–8.
  64. Taniyama Y, Ito H, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al. Beneficial effect of intracoronary verapamil on microvascular and myocardial salvage in patients with acute myocardial infarction. J Am Coll Cardiol. 1997;30(5):1193–9.
  65. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med. 2007;357(11):1121–35.
  66. Andreotti F, Pasceri V, Hackett DR, Davies GJ, Haider AW, Maseri A. Preinfarction angina as a predictor of more rapid coronary thrombolysis in patients with acute myocardial infarction. N Engl J Med. 1996;334(1):7–12.
  67. Przyklenk K, Bauer B, Ovize M, Kloner RA, Whittaker P. Regional ischemic “preconditioning” protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation. 1993;87(3):893–9.
  68. Kharbanda RK, Nielsen TT, Redington AN. Translation of remote ischaemic preconditioning into clinical practice. Lancet. 2009;374(9700):1557–65.
  69. Venugopal V, Hausenloy DJ, Ludman A, Di Salvo C, Kolvekar S, Yap J, et al. Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial. Heart. 2009;95(19):1567–71.
  70. Hoole SP, Heck PM, Sharples L, Khan SN, Duehmke R, Densem CG, et al. Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial. Circulation. 2009;119(6):820–7.
  71. Botker HE, Kharbanda R, Schmidt MR, Bottcher M, Kaltoft AK, Terkelsen CJ, et al. Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial. Lancet. 2010;375(9716):727–34.