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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction

Lara S F Konijnenberg1, Peter Damman1, Dirk J Duncker2

  • 1Department of Cardiology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands.

Cardiovascular Research
|November 12, 2019
PubMed

Insights

Primary percutaneous coronary intervention (PCI) restores epicardial artery blood flow in ST-elevation myocardial infarction (STEMI) but often fails to restore microvascular perfusion, leading to worse outcomes. This review explores coronary microvascular dysfunction (CMD) in STEMI.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Biomedical Engineering

Background:

  • Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
  • Despite successful epicardial artery reperfusion in >95% of STEMI cases, approximately half of patients develop coronary microvascular dysfunction (CMD).
  • Post-ischaemic CMD is linked to increased morbidity and mortality in STEMI patients.

Purpose of the Study:

  • To review diagnostic and quantification techniques for CMD in STEMI.
  • To explore the pathophysiology of CMD using in vitro and in vivo experimental models.
  • To discuss future therapeutic strategies for CMD in STEMI.

Main Methods:

  • Review of invasive and non-invasive diagnostic techniques for CMD.
  • Analysis of experimental data from in vitro and in vivo models of myocardial infarction.
  • Synthesis of current literature on CMD pathophysiology and treatment.

Main Results:

  • Angiographically complete epicardial reperfusion does not guarantee microvascular function restoration.
  • Ischaemia, reperfusion injury, and inflammation significantly impact coronary microvascular endothelial cells.
  • CMD diagnosis and quantification methods are crucial for risk stratification.

Conclusions:

  • Coronary microvascular dysfunction (CMD) remains a significant challenge post-ST-elevation myocardial infarction (STEMI) despite successful epicardial reperfusion.
  • Understanding the mechanisms of CMD is vital for developing targeted therapies.
  • Further research into preventing and treating CMD is essential for improving STEMI patient outcomes.

Keywords:
Coronary microvascular dysfunctionCoronary microvascular endothelial cellsIntramyocardial haemorrhageMicrovascular reperfusion injuryST-elevation myocardial infarction

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