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Coronary No-Reflow after Primary Percutaneous Coronary Intervention-Current Knowledge on Pathophysiology, Diagnosis,

Gjin Ndrepepa1, Adnan Kastrati1,2

  • 1Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.

Journal of Clinical Medicine
|September 9, 2023
PubMed

Insights

Coronary no-reflow (CNR) is a common complication after ST-segment elevation myocardial infarction (STEMI) reperfusion therapy. Current therapies do not prevent or reverse CNR, highlighting an unmet need in STEMI treatment.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Medical Imaging

Background:

  • Coronary no-reflow (CNR) is a frequent complication following reperfusion therapy for ST-segment elevation myocardial infarction (STEMI).
  • Microvascular obstruction (MVO) due to ischemia, embolization, and reperfusion injury is the primary mechanism of CNR.
  • CNR negatively impacts the benefits of reperfusion therapy, leading to adverse left ventricular remodeling, heart failure, and reduced survival.

Purpose of the Study:

  • To review the pathophysiology, diagnosis, and clinical implications of coronary no-reflow (CNR) in STEMI patients.
  • To highlight the limitations of current diagnostic tools and the lack of effective therapies for CNR.
  • To emphasize the ongoing research into preventing and alleviating MVO and CNR.

Main Methods:

  • Review of existing literature on coronary no-reflow (CNR) and microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI).
  • Comparison of diagnostic modalities, including coronary angiography and cardiac magnetic resonance (CMR) imaging.
  • Analysis of the impact of CNR/MVO on clinical outcomes and the effectiveness of current therapeutic strategies.

Main Results:

  • CNR is dynamic, developing over hours and persisting for weeks after reperfusion.
  • Coronary angiography underestimates CNR frequency, while CMR imaging is highly sensitive for MVO detection, localization, and extent, also identifying intramyocardial hemorrhage and estimating infarct size.
  • Despite research targeting known mechanisms, no therapy consistently prevents or reverses CNR and improves clinical outcomes in STEMI patients.

Conclusions:

  • Microvascular obstruction (MVO) and coronary no-reflow (CNR) significantly negate reperfusion benefits in STEMI, contributing to poor prognosis.
  • Effective prevention or reversal of MVO and CNR remains a critical unmet therapeutic goal in STEMI management.
  • Continued research is essential to address the challenges posed by MVO and CNR in STEMI patients undergoing reperfusion therapy.

Keywords:
coronary no-reflowmicrocirculation steal syndromemicrovascular obstructionpathophysiologytherapy

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