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Pathophysiology, prevention, and management of coronary microvascular obstruction
(Oxford University Press (OUP), 2026-05-26)
Cenko, Edina
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Badimon, Lina
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Vadalà, Giuseppe
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Merkus, Daphne
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Antoniades, Charalambos
Abstract Although prompt primary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-elevation myocardial infarction (STEMI), the burden of post-infarction heart failure remains considerable and is expected to increase. A major contributory factor is suboptimal myocardial reperfusion, which persists in up to 60% of cases even with timely revascularization. This is largely driven by microvascular obstruction and ischaemia–reperfusion injury, culminating in the no-reflow phenomenon, a critical prognostic factor associated with impaired infarct healing, adverse left ventricular remodelling, and increased risk of heart failure and death. No-reflow is a complex and heterogeneous phenomenon, identifiable through different invasive and noninvasive technologies. When observed post-PCI, after excluding residual epicardial stenosis, it indicates poor microvascular perfusion and necessitates urgent management. Identifying patients at high risk and implementing early targeted interventions are essential to improving outcomes. Pharmacological therapies, including intracoronary adenosine and nitroprusside, have shown unclear benefit in improving microvascular flow. Non-pharmacological strategies, such as ischaemic postconditioning, intracoronary supersaturated oxygen therapy, stent-retriever thrombectomy, and mechanical left ventricular unloading, have demonstrated promise but require further validation in large-scale clinical trials. This clinical consensus statement summarizes current strategies for the prevention and treatment of no-reflow and underscores the need for improved risk stratification and novel microvasculature-targeted therapies. Addressing this persistent and significant unmet clinical need is crucial for improving care for STEMI patients and for mitigating its long-term complications, including heart failure and mortality.
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HEART BLOCK AS A COMPLICATION OF ACUTE MYOCARDIAL INFARCTION, CLINICAL ASSESSMENT AND APPROACH. A CASE REPORT
(Faculty of Medical Sciences, University of Tetova, 2023-09-24)
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Murtezani, Besir
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Zhaku, Vegim
Optimal treatment for acute ST-elevation myocardial infarction (STEMI) within 12 hours after symptom onset includes primary percutaneous coronary intervention (PCI) or thrombolytic therapy. For STEMI patients who present later than 12 hours, current guidelines do not recommend PCI except the presence of hemodynamic or electrical instability or continuing ischemic symptoms. Thus, our intention is to show that early reperfusion may also play a role in the early recovery of AV block that may occur as a complication of myocardial infarction (MI), more commonly inferior MI. Patient 49 years old patient (male) presented in our department with weakness, dizziness, short-term instability and nausea. The symptoms started one day before admission. The ECG on admission showed a total AV block with a heart rate approximately 33 b/min and ST segment elevation in the inferior leads. Laboratory tests were normal except for an extreme elevated high sensitive troponin. The echo showed normal finding with the exception of the slightly reduced kinetics of the apex, base and mid segment of the lower-posterior wall of the IVS. Coronary angiography was immediately performed, showing 100% stenosis of the rPDA. A stent is placed on the corresponding coronary artery. The total block was present all the time, and following the recommendations, a temporary pacemaker was placed in the patient due to hemodynamic instability and bradycardia. Despite reperfusion, the block persisted 7 days after the intervention, during which a permanent pacemaker was implanted and the patient was discharged for home treatment. This case highlights the importance and ways of early reperfusion to improve outcomes in patients with STEMI. Early reperfusion may also play a role in the early recovery of AV block that may occur as a complication of MI, more commonly inferior MI.
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Role of optical coherence tomography in complex percutaneous coronary interventions(case report)
(Македонско здружение по Кардиологија, 2021-10)
Bushljetikj O
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Zdravkovski I
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