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Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
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The Coronary Venous System in Acute Coronary Syndrome: A Narrative Review

Ercan Akşit1, Cengiz Demir2, Uğur Özpınar3

  • 1Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Canakkale, Turkey.

Biomedicines
|May 27, 2026
PubMed

Insights

The coronary venous system (CVS) plays a critical role in acute coronary syndrome (ACS) by influencing myocardial ischemia and reflecting reperfusion outcomes. Understanding CVS abnormalities is vital for managing ACS, a major global health concern.

Area of Science:

  • Cardiovascular Physiology
  • Cardiac Pathophysiology
  • Venous System Dynamics

Background:

  • Acute coronary syndrome (ACS) is a major cause of mortality, with research focusing primarily on arterial and microvascular issues.
  • The coronary venous system (CVS), crucial for myocardial blood return, is understudied in the context of ACS.
  • Understanding the CVS is essential as its abnormalities can cause ischemia, and its flow reflects reperfusion status.

Purpose of the Study:

  • To review the pathophysiological mechanisms of the coronary venous system (CVS) in acute coronary syndrome (ACS).
  • To examine the hemodynamic behavior of the CVS during ACS, including ischemia and reperfusion.
  • To explore the role of the coronary sinus (CS) in ACS pathophysiology.

Main Methods:

  • Literature review focusing on the coronary venous system (CVS) and its role in acute coronary syndrome (ACS).
  • Analysis of existing experimental and clinical evidence regarding coronary sinus (CS) thrombosis and blood flow in ACS.
  • Exploration of the 'vascular waterfall' phenomenon in relation to coronary venous return.

Main Results:

  • Coronary venous system (CVS) abnormalities can contribute to myocardial ischemia.
  • Coronary sinus (CS) thrombosis is linked to myocardial infarction and can complicate ACS.
  • Coronary sinus (CS) blood flow typically decreases during acute ischemia and increases post-reperfusion.

Conclusions:

  • The coronary venous system (CVS) is an underappreciated component in the pathophysiology of acute coronary syndrome (ACS).
  • Further research into the CVS is needed to fully understand and manage ACS.
  • The CVS offers insights into hemodynamic outcomes following myocardial ischemia and reperfusion events.

Keywords:
acute coronary syndromecoronary sinus thrombosiscoronary venous systemmyocardial venous bridgepersistent left superior vena cava

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