Primary percutaneous coronary intervention (PPCI) is nowadays the preferred reperfusion strategy for treating ST-elevation myocardial infarction (STEMI) patients, aiming at restoring epicardial infarct-related artery patency and achieving microvascular reperfusion as early as possible, thus limiting the extent of irreversibly injured myocardium. Yet, in a sizeable proportion of patients, PPCI achieves epicardial coronary artery reperfusion but not myocardial reperfusion due to the occurrence of coronary microvascular obstruction (CMVO), a condition clinically known as no-reflow. Prevalence of CMVO is variable, ranging from 5% up to 50%, according to the methods used to assess the phenomenon and to the population under study. Indeed, CMVO can be assessed using different techniques and at different time points after STEMI. In this chapter, we review the available data regarding the incidence of CMVO in STEMI patients according to different reperfusion strategies (PPCI, effective thrombolysis, and rescue PCI) and according to the different modalities of its detection. Finally, we analyzed data in the literature reporting the incidence of CMVO in different clinical subsets (diabetes, chronic kidney disease, women, and latecomers) and different subset of lesions (saphenous vein graft).
|Titolo:||Epidemiology of coronary microvascular obstruction|
|Data di pubblicazione:||2018|
|Appare nelle tipologie:||2.1 Contributo in volume(Capitolo di libro)|