Role of adenosine as an adjunct therapy in the prevention and treatment of no-reflow phenomenon in acute myocardial infarction with ST segment elevation: review of the current data

2013 ◽  
pp. 115-120 ◽  
Author(s):  
Marek Grygier ◽  
Aleksander Araszkiewicz ◽  
Maciej Lesiak ◽  
Stefan Grajek
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Current Data ◽  
Adjunct Therapy ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Prevention And Treatment ◽  
No Reflow Phenomenon

scholarly journals Assessment of no-reflow phenomenon by myocardial contrast echocardiography in patients with acute myocardial infarction with ST-segment elevation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D Krinochkin ◽  
I Bessonov ◽  
E Yaroslavskaya ◽  
V Kuznetsov
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Contrast Echocardiography ◽  
Left Ventricular ◽  
Myocardial Contrast Echocardiography ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
No Reflow Phenomenon

Abstract Funding Acknowledgements Type of funding sources: None. Background The noninvasive assessment of myocardial perfusion by echo contrast agents in patients with acute myocardial infarction with ST-segment elevation (STEMI) after successful revascularization is becoming a relevant clinical reality. Perfusion imaging techniques with myocardial contrast echocardiography (MCE) remains the least studied and most promising ultrasound technology for the diagnosis of no-reflow phenomenon. Purpose To study the echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by MCE in patients with STEMI. Methods The study included 43 patients aged from 40 to 82 years in acute stage of myocardial infarction. Patients were divided into two groups: 32 patients characterized by sufficient myocardial reperfusion after revascularization according to MCE results and 11 patients were with the impaired perfusion. Results The patients with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1 ± 2.2% vs 27.4 ± 8.5%, p < 0.001). LV dilatation (LV end-systolic volume 67.3 ± 20.3 ml vs 51.8 ± 17.2 ml, p = 0.015), impaired LV ejection fraction (39.5 ± 3.4% vs 47.2 ± 4.9%, p < 0.001), and significant mitral regurgitation (45.5% vs 3.1%, p = 0.011) with a decrease in DP/DT (979.9 ± 363.4 mmHg/s vs 1565.7 ± 502.8 mmHg/s, p < 0.001) was more often detected in this group. In more than a quarter of these patients, coronary angiography showed no perfusion disorders after revascularization. In the group with impaired perfusion by MCE, the single-vascular lesions (46.9% vs 9.1%, p = 0.033), the lesions of the anterior interventricular artery (90.9% vs 40.6%, p = 0.004), and acute occlusion (100% vs 68.8%, p = 0.043) were more often determined. Conclusion According to the results of MCE, the echo signs of LV dysfunction were more pronounced after successful revascularization in patients with STEMI and myocardial perfusion disorders. The SYNTAX score was twice higher in these patients compared to the patients with recovered perfusion. In addition, no-reflow phenomenon by MCE was observed in the most patients with anterior interventricular artery lesion.

A macrophage migration inhibitory factor as a predictor of reperfusion myocardial injury in patients with st-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Vishnevskaya ◽  
T.Y.E Storozhenko ◽  
M.P Kopytsya
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Macrophage Migration Inhibitory Factor ◽  
Myocardial Injury ◽  
Macrophage Migration ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
No Reflow Phenomenon

Abstract Introduction Major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) are still common despite the modern treatment approaches. It may be caused by the “no-reflow” phenomenon. One of the promising biomarkers for the coronary “no-reflow” phenomenon prediction is proinflammatory cytokine macrophage migration inhibitory factor (MIF). Purpose To estimate the role of MIF in the prediction of early reperfusion myocardial injury in patients with STEMI. Methods The study involved 341 STEMI patients (78.6% male and 21.4% female) with an average age of 59.08±9.65 years. Control group of 12 healthy volunteers included. All patients were made to undergo a baseline investigation. In addition, the level of MIF determined twice during the first 12 hours of STEMI, before the percutaneous coronary intervention (PCI) and after the procedure. Coronary blood flow evaluated using TIMI flow grade and myocardial blush grade (MBG). All patients had epicardial blood flow TIMI 3. The criteria for “no-reflow” diagnosis were myocardial perfusion at MBG 0 or MBG 1 level with complete recovery of epicardial blood flow or ST-segment resolution (rST) of less than 70% from baseline within 2 hours after PCI. All patients were divided into two groups according to MBG and rST after PCI more and less than 70%: 147 patients in the first group with MBG stage 0–1, 182 patients with MBG stage 2–3 Results 64% of STEMI patients had elevated MIF levels above the highest value in healthy controls (2778±217 ng/ml; 225±6,7 ng/ml; p=0,0003). The level of MIF biomarker, determined before PCI was significantly higher in the group of patients with MBG 0–1 in comparison to MBG 2–3. (4708±471 ng/ml vs 2914±347ng/ml; p=0,004). Using the multivariate regression analysis, the dependencies of the biomarker MIF on the parameters of the reperfusion myocardial injuries were obtained. MIF measured before revascularization as well as the patient's gender, was an independent predictor of MBG 0–1 and rST less than 70% (coefficients Beta 0,1; odd ratio 1,1; 95%confidential interval (CI) 1,0–1,2; p=0,037 and coefficient Beta 2,9; odd ratio 17.7; 95% CI 0,96–32; p=0,05, respectively). Conclusions The study revealed that MIF predicts reperfusion myocardial injury in patients with STEMI. Future investigations of the MIF biological effects are the perspective direction in the field of modern cardiology. Funding Acknowledgement Type of funding source: None

scholarly journals Circulating miR-660-5p is associated with the no-reflow phenomenon in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian-wei zhang ◽  
Cheng-ping Hu ◽  
Ying-xin Zhao ◽  
Ling-jie He
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
No Reflow ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background: The no-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI.Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included in the study; in these patients, coronary angiography confirmed that the infarct-related artery was the left anterior descending (LAD) artery. Angiographic NRP was defined as a final TIMI flow of 2 or a final TIMI flow of 3 with a myocardial blush grade (MBG) < 2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple logistic regression analysis.Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean BMI: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). Patients were divided into tertiles by miR-660-5p levels (Q1: ≤ 7.18, Q2: 7.18-11.31, Q3: > 11.31). Patients in the high microRNA-660-5p group had almost a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [(odds ratio (OR)=5.68, 95% confidence interval (CI) 1.40-23.07, p=0.015). When analysed by tertiles, consistent trends of an increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25, 95% CI: 0.27-5.73, p=0.77; OR2 for Q3 VS. Q1: 5.96, 95% CI: 1.33-26.66, p=0.02), even after multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention with an area under the curve (AUC) of 0.768 (95% CI: 0.636-0.890).Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.

No-reflow phenomenon in ST-segment elevation myocardial infarction: still the Achilles’ heel of the interventionalist

2020 ◽  
Author(s):  
Jonathan L Ciofani ◽  
Usaid K Allahwala ◽  
Roberto Scarsini ◽  
Avedis Ekmejian ◽  
Adrian P Banning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Management Algorithms

Improvements in systems, technology and pharmacotherapy have significantly changed the prognosis over recent decades in patients presenting with ST-segment elevation myocardial infarction. These clinical achievements have, however, begun to plateau and it is becoming increasingly necessary to consider novel strategies to further improve outcomes. Approximately a third of patients treated by primary percutaneous coronary intervention for ST-segment elevation myocardial infarction will suffer from coronary no-reflow (NR), a condition characterized by poor myocardial perfusion despite patent epicardial arteries. The presence of NR impacts significantly on clinical outcomes including left ventricular dysfunction, heart failure and death, yet conventional management algorithms neither assess the risk of NR nor treat NR. This review will provide a contemporary overview on the pathogenesis, diagnosis and treatment of NR.

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