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Cardiovasc Res. 2019 Jun 1;115(7):1143-1155. doi: 10.1093/cvr/cvy286.

The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection.

Author information

1
Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
2
National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
3
Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
4
The Hatter Cardiovascular Institute, University College London, London, UK.
5
The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, Research & Development, London, UK.
6
Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
7
Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, USA.
8
Department of Cardiovascular and Thoracic Sciences, F. Policlinico Gemelli-IRCCS, Università Cattolica Sacro Cuore, Roma, Italy.
9
Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary.
10
Pharmahungary Group, Szeged, Hungary.
11
Department of Cardiology, Vascular Biology and Metabolism Area, Vall d'Hebron University Hospital and Research Institute (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain.
12
Instituto CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
13
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
14
Institute of Physiology, Justus-Liebig University Giessen, Giessen, Germany.
15
Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany.

Abstract

The coronary circulation is both culprit and victim of acute myocardial infarction. The rupture of an epicardial atherosclerotic plaque with superimposed thrombosis causes coronary occlusion, and this occlusion must be removed to induce reperfusion. However, ischaemia and reperfusion cause damage not only in cardiomyocytes but also in the coronary circulation, including microembolization of debris and release of soluble factors from the culprit lesion, impairment of endothelial integrity with subsequently increased permeability and oedema formation, platelet activation and leucocyte adherence, erythrocyte stasis, a shift from vasodilation to vasoconstriction, and ultimately structural damage to the capillaries with eventual no-reflow, microvascular obstruction (MVO), and intramyocardial haemorrhage (IMH). Therefore, the coronary circulation is a valid target for cardioprotection, beyond protection of the cardiomyocyte. Virtually all of the above deleterious endpoints have been demonstrated to be favourably influenced by one or the other mechanical or pharmacological cardioprotective intervention. However, no-reflow is still a serious complication of reperfused myocardial infarction and carries, independently from infarct size, an unfavourable prognosis. MVO and IMH can be diagnosed by modern imaging technologies, but still await an effective therapy. The current review provides an overview of strategies to protect the coronary circulation from acute myocardial ischaemia/reperfusion injury. This article is part of a Cardiovascular Research Spotlight Issue entitled 'Cardioprotection Beyond the Cardiomyocyte', and emerged as part of the discussions of the European Union (EU)-CARDIOPROTECTION Cooperation in Science and Technology (COST) Action, CA16225.

KEYWORDS:

Cardioprotection; Coronary circulation; Ischaemia; Microvascular obstruction; Reperfusion

PMID:
30428011
PMCID:
PMC6529918
[Available on 2020-06-01]
DOI:
10.1093/cvr/cvy286

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