Coronary microvascular obstruction and dysfunction in patients with acute myocardial infarction

Despite prompt epicardial recanalization in patients presenting with ST-segment elevation myocardial infarction (STEMI), coronary microvascular obstruction and dysfunction (CMVO) is still fairly common and is associated with poor prognosis. Various pharmacological and mechanical strategies to treat CMVO have been proposed, but the positive results reported in preclinical and small proof-of-concept studies have not translated into benefits in large clinical trials conducted in the modern treatment setting of patients with STEMI. Therefore, the optimal management of these patients remains a topic of debate. In this Review, we appraise the pathophysiological mechanisms of CMVO, explore the evidence and provide future perspectives on strategies to be implemented to reduce the incidence of CMVO and improve prognosis in patients with STEMI.Coronary microvascular obstruction and dysfunction (CMVO) is common in patients with ST-segment elevation myocardial infarction (STEMI) despite prompt reperfusion. In this Review, the authors discuss the mechanisms of CMVO as well as strategies to reduce its incidence and improve prognosis.Coronary microvascular obstruction and dysfunction (CMVO) is fairly common in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with poor prognosis.Prompt epicardial recanalization by timely primary percutaneous coronary intervention (PPCI) is the most effective strategy for the treatment and prevention of CMVO but is also a relevant confounding factor in the assessment of additional strategies to reduce CMVO in the modern management of patients with STEMI.The optimal strategies to reduce CMVO in clinical practice remain debated, given that promising results from preclinical and small proof-of-concept studies have often not translated into similarly positive results in large-scale clinical trials.The increasing understanding of the underlying mechanisms and the availability of more advanced tools for the prompt and precise identification of patients at high risk of CMVO will be important in the design of future randomized controlled trials in this field.The prevention, precise and timely identification, and multi-pathway treatment (simultaneously targeting several pathophysiological mechanisms) of CVMO is a promising approach to improve outcomes in patients with STEMI.Further studies are warranted to identify safe and effective pharmacological or mechanical strategies to reduce CMVO in patients with STEMI undergoing PPCI.