Coronary Microvascular Obstruction in Acute Myocardial Infarction: From Mechanisms to Treatment

 

Description:

 

Coronary Microvascular Obstruction in Acute Myocardial Infarction: From Mechanisms to Treatment provides a comprehensive understanding of the phenomenon of coronary microvascular obstruction (CMVO) that is the main limitation of reperfusion therapies in ST-elevation myocardial infarction. It provides in-depth coverage of the phenomenon of CMVO which heavily affects prognosis by increasing the risk of death and heart failure at follow-up. A first of its kind reference dedicated solely to this topic, it is appropriate for a wide audience, from researchers, to those who aid in the management, prevention and treatment of CMVO.

Provides in-depth coverage of coronary microvascular obstruction (CMVO), spanning research, management, prevention and treatment

Includes the most up-to-date information on CMVO as presented from top experts around the word

Provides access to a companion website with extra material, including tables, additional references and instructional videos

Gives extensive coverage on how to measure CMVO, including in-depth indexes that can be used to detect and quantify the phenomenon

 

Table of Contents:

 

1 Pathogenesis of ST-Elevation Myocardial Infarction

Introduction

Development of Coronary Atherosclerosis and Plaque De-Stabilization

Endothelium and Vascular Function

Progression of Vascular Damage: Smooth Muscle Cells and Extracellular Matrix

Complication by Inflammation: Innate and Acquired Immunity

High-Risk Plaques and Atherothrombosis

Characteristics of Acute Intracoronary Thrombosis

Platelets in Coronary Thrombosis

Activation of the Coagulation Cascade

Platelet Released Microvesicles

Characteristics of Myocardial Ischemia and Cardiomyocyte Necrosis

Biochemical Markers for Detecting Myocardial Necrosis

Tissue Infarction and Myocardial Damage

References

Further Reading

2 Reperfusion Therapy in ST-Elevation Myocardial Infarction

Fibrinolytic Therapy in ST-Segment-Elevation Myocardial Infarction

“Rescue” and Early Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarct

“Primary” Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction

Primary Percutaneous Coronary Intervention Versus Thrombolysis

Primary Percutaneous Coronary Intervention With or Without “Stenting” for the Treatment of ST-Se

Early Thrombolysis With Delayed Percutaneous Coronary Intervention: The “Pharmaco-Invasive” Stra

Multivessel Coronary Artery Disease in ST-Segment-Elevation Myocardial Infarction

Cardiogenic Shock and Resuscitated Cardiac Arrest

Adjunctive Interventions and Pharmacotherapy to Improve Outcomes in ST-Segment-Elevation Myocardial

Dual Antiplatelet Therapy

Glycoprotein IIb/IIIa Platelet Receptor Inhibitors

Manual Thrombus Aspiration

Radial Versus Femoral Arterial Primary Percutaneous Coronary Intervention Access

New-Generation Drug-Eluting Stents

Future Advances to Optimize Clinical Outcomes in ST-Segment-Elevation Myocardial Infarction

References

3 Epidemiology of Coronary Microvascular Obstruction

Introduction

Incidence of Coronary Microvascular Obstruction in Patients Treated With Primary Percutaneous Corona

Angiographic Indexes

Cardiac Magnetic Resonance

Myocardial Contrast Echocardiography

Electrocardiographic ST-Resolution

Incidence of Coronary Microvascular Obstruction in Patients Treated With Thrombolysis

Incidence of Coronary Microvascular Obstruction in Patients Treated With Rescue Primary Percutaneous

Incidence of Coronary Microvascular Obstruction in Specific Subset of Patients

Diabetes

Women

Chronic Kidney Disease

Saphenous Vein Graft

Latecomers

Conclusions

References

4 Individual Predisposition to Coronary Microvascular Obstruction

Introduction

Coronary Microvascular Physiology

Risk Factors for Coronary Microvascular Disease

Contributions of Coronary Microvascular Function to Subsequent Microvascular Obstruction

Prevention Strategies to Improve Microvascular Function

Lifestyle Modification–Diet and Exercise

Nitrates

Angiotensin Converting Enzyme (ACE) Inhibitors

Beta-Blockers

Calcium Channel Antagonists

Statins

Ranolazine

Phosphodiesterase Inhibition

L-Arginine

Conclusions

References

5 Coronary Microembolization and Microvascular Dysfunction

Highlights

Morphology

Pathophysiology

Coronary Microembolization in Cardiac Imaging

Coronary Microembolization Versus Cardioprotection

In Vitro Characterization of Coronary Aspirate From Patients Undergoing PCI

Coronary Microembolization Versus Coronary Microvascular Dysfunction—A Perspective

References

6 Role of Ischemia–Reperfusion Injury in Coronary MVO

Oxygen Free Radicals

Microvascular Dysfunction

Microvascular Compression

Neutrophil Plugging

Microthrombi Formation

Soluble Vasoconstrictors and Thrombogenic Factors

Postreperfusion Hemorrhage

References

7 Angiography and Electrocardiography (ECG) for the Assessment of Coronary Microvascular Obstruction

Coronary Angiography

Thrombolysis in Myocardial Infarction Flow Score

Thrombolysis in Myocardial Infarction (TIMI) Frame Count

Other Angiographic Parameters to Describe the Effectiveness of Myocardial Reperfusion

Myocardial Blush Grades

TIMI Myocardial Perfusion Grade

Electrocardiogram

ST Resolution Quantification

ST-Segment Elevation Resolution and Diagnosis of Microvascular Obstruction

Correlation of STR with Other Imaging Techniques of MVO

Postprocedural Residual Cumulative ST-Segment Deviation and ST Depression Resolution

Q Waves and QRS for Prediction of Poor Microvascular Reperfusion

References

8 Invasive Assessment of Coronary Microvascular Obstruction

Introduction

Invasive Techniques for Assessment of Microvascular Obstruction

Angiography-Based Techniques

TIMI Flow Grade

Corrected TIMI Frame Count

Myocardial Blush Grade and TIMI Myocardial Perfusion Grade

Quantitative Blush Evaluator

Intracoronary Doppler-Based Techniques

Diastolic Flow Deceleration and Systolic Flow Reversal

Coronary Flow Velocity Reserve

Hyperemic Microvascular Resistance

Zero-Flow Pressure

Wave Intensity Analysis

Thermodilution-Derived Techniques

Thermodilution-Derived Coronary Flow Reserve

Index of Microcirculatory Resistance

Absolute Coronary Blood Flow Assessment

Conclusion

References

9 Imaging Modalities for the Assessment of CMVO

Imaging Modalities for the Assessment of CMVO

Myocardial Scintigraphy and PET

Computed Tomography

Myocardial Contrast Echocardiography

CMR Imaging

Conclusions

References

10 Intracoronary Imaging for Assessing the Risk of Coronary Microvascular Obstruction

Introduction

Intravascular Ultrasound

Optical Coherence Tomography

Other Imaging Modalities

Conclusions

References

11 A Comprehensive Prognostic Assessment of ST-Elevation Myocardial Infarction by Cardiac MRI

Introduction

Myocardial Function

Left Ventricular Ejection Fraction

Other Parameters of Left Myocardial Function

Right Myocardial Function

Infarct Size

Microvascular Injury

Microvascular Obstruction

Intramyocardial Hemorrhage

Myocardial Salvage

Remote Myocardium

References

12 Prognosis of Coronary Microvascular Obstruction

Introduction

ST-Segment Resolution

Coronary Angiography

Invasive Assessment

Cardiac Magnetic Resonance

References

13 Prevention of Coronary Microvascular Obstruction by Addressing the Individual Susceptibility

Introduction

Pre-Existent Microvascular Dysfunction

Major Cardiovascular Risk Factors

Hyperglycemia

Hypercolesterolemia

Arterial Hypertension

Smoking

Aging

Gender

Minor Cardiovascular Risk Factors

Inflammation

Hyperhomocystinemia

Renal Dysfunction

Genetic Factors

Ischemic Pre-Conditioning and Its Modulation

Therapies for the Improvement of Individual Susceptibility

Conclusions

References

14 Prevention of Coronary Microvascular Obstruction by Addressing Distal Embolization

Pathophysiology of Microvascular Obstruction and Distal Embolization

Thrombus Aspiration Catheters

Evidence for Manual Thrombus Aspiration

Thrombus Aspiration in Patients with High Thrombus Burden

Distal Embolic Protection Devices

Mesh Covered Stents

Direct Stenting

Deferred Stenting

Intra Coronary Thrombolysis

Potential for Therapy to Cause Harm

Conclusion

Acknowledgements

References

15A Prevention of Coronary Microvascular Obstruction by Addressing Ischemia Reperfusion Injury—Par

Introduction

Scientific Evidence

Antiplatelets

Glycoprotein IIb/IIIa Inhibitors

P2Y12 Receptor Antagonists

Statins

Vasodilators

Adenosine

Nitroprusside

Nicorandil

Calcium Channel Blockers

Natriuretic Peptides

Other Vasodilators

Summary of Evidence and Guideline Recommendations

Conclusions and Future Perspective

References

15B Prevention of Microvascular Obstruction by Addressing Ischemia Reperfusion Injury—Part B: Card

Pharmacological Therapies

Agents Targeting Mitochondrial Integrity

Cyclosporine A

Bendavia

Translocator Protein 18kDa Antagonist, TRO40303 (MITOCARE)

Protein Kinase C Inhibitors: Delcasertib, KAI-9803

Glucose Modulators

Glucose–Insulin–Potassium

Antidiabetic Drugs

Beta-Blockers

Metoprolol

Carvedilol and Nebivolol

Short Half-Life Beta-Blockers: Esmolol and Landiolol

Atrial Natriuretic Peptide

Inhaled Oxygen

N-Acetylcysteine

Erythropoietin

Mechanical Therapies

Ischemic Conditioning

Ischemic Pre-Conditioning

Ischemic Post-Conditioning

Remote Ischemic Conditioning

Hypothermia

Other Mechanical Therapies

References

16 Why Did All Treatments of Reperfusion Injury Failed in Humans?

Reperfusion Injury: A Brief Historical Overview

Experimental Demonstration of Protection Against Reperfusion Injury

First Clinical Evidence of Reperfusion Injury in Acute Myocardial Infarction Patients

Questioning the Clinical Benefit of Preventing Lethal Myocardial Reperfusion Injury

Measuring “Reperfusion Injury”: The Major Unresolved Issue

When Do Cells Die?

The Link Between Ischemia- and Reperfusion Injuries

General Context

Poorly Known Mechanisms and Naive Therapeutic Approach

What Models Do Not Tell

Experimental Models

Human Models

Cardiac Surgery As a Model

Infarct Size Reduction Studies in ST-Elevation Myocardial Infarction

Clinical Outcomes Studies

Effect Modifiers

Comorbidities

Co-Treatments

The Protective Intervention

How to Move Forward?

References

Further Reading

17 A Multi Target and Multi Timing Strategy for the Management of Coronary Microvascular Obstruction

Introduction

Treatment Strategies in Different Time Windows

Before the Catheterization Laboratory

In the Catheterization Laboratory

Thrombus Management

Vasodilators and Other Drugs

Deferred Stenting

Ischemic Postconditioning

After the Catheterization Laboratory

References

18 Temporal Evolution of Coronary Microvascular Obstruction

Introduction

Evolution of Coronary Microvascular Obstruction Early After Coronary Artery Recanalization

Evolution of Coronary Microvascular Obstruction in the First Days-Weeks After Myocardial Infarction

Evolution of Coronary Microvascular Obstruction Late After Myocardial Infarction

Functional and Prognostic Correlates of Temporal Evolution of Microvascular Obstruction

References

19 Long-Term Management After Coronary Microvascular Obstruction Complicating Reperfusion in ST-Elev

Management After the Catheterization Laboratory Within Hospital

Long-Term Management After Discharge

Identification of High-Risk Patients Beyond Low Ejection Fraction

Treatment for CMVO Beyond Risk Factor Modification, Guideline-Based Therapy Against Heart Failure, a

Intensified Antithrombotic Therapy

Vascular Endothelial Growth Factors

Stem Cells

Exosomes

Long-Term Remote Ischemic Conditioning

Conclusion

References

Index

Back Cover

 

An aparitie	10 July 2018
Autor	Giampaolo Niccoli MD PhD , Ingo Eitel MD
Editura	Elsevier
Format	Paperback
ISBN	9780128125281
Limba	Engleza
Nr pag	400