Colin Berry1,2*, PhD, FESC; Annette M. Maznyczka1,2, BSc (Hons), MRCP; Peter McCartney1,2, MRCP
1. British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; 2. West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
Primary percutaneous coronary intervention (PCI) is the evidence-based standard of care for patients with acute ST-segment elevation myocardial infarction (STEMI)1. Despite routinely restoring coronary flow2, failed myocardial reperfusion, or microvascular obstruction, affects approximately half of patients2, increasing the risk of death and heart failure in the longer term2,3. Primary PCI should not be considered successful when microvascular obstruction has occurred.
Microvascular obstruction is caused by intrinsic and extrinsic vascular processes (Figure 1). The intrinsic problems include impaired flow, microvascular thrombosis, distal embolisation of thrombus/atheroma, vasospasm and endothelial damage. The extrinsic problems include microvascular compression due to oedema and ...