Assessing and managing coronary microcirculation dysfunction in acute ST-segment elevation myocardial infarction

ABSTRACT

Introduction: Microvascular dysfunction in the setting of acute ST-segment elevation myocardial infarction (STEMI) is an indicator of poor long-term prognosis. Prompt assessment and pharmacological or procedural therapy (prophylactic or post onset of dysfunction) may improve outcomes in STEMI post-primary percutaneous intervention.

Areas covered: The aim of this review is to provide a comprehensive analysis of the evidence available about the assessment and management of coronary microcirculatory injury/dysfunction in STEMI. We also aim to elucidate the possible strategies that could be applied in clinical practice to support the application of already available or novel therapeutic strategies for the prevention and management of microvascular impairment.

Expert commentary: There are multiple established methods in assessing microvascular dysfunction, both non-invasively and invasively. Invasive physiological measurements allow real-time assessment of microvascular dysfunction and have prognostic cut-off values. Multiple therapeutic modalities exist for both preventing and treating microvascular dysfunction. These can be either pharmacological or mechanical, and there is no algorithm to guide if, how and when to apply them. Future research into both procedural and pharmacological therapy guided by physiological measurements is needed, with the aim of recognizing high-risk patients who would benefit from therapy.

KEYWORDS:

• Coronary angiography
• coronary microcirculation
• invasive physiology
• microvascular dysfunction
• microvascular therapy
• myocardial infarction

Note

1. We additionally examined the influence of age and BMI on these results, as suggested by a reviewer. The results did not change with these covariates, and neither age nor BMI were significant predictors. Therefore, the original hypotheses and analyses are presented here.

Declaration of interest

A Banning has received an unrestricted research grant to his institution from Boston Scientific to fund an interventional fellowship. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.