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European Heart Journal Advance Access published online on March 8, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl501
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Microcirculatory dysfunction in ST-elevation myocardial infarction: cause, consequence, or both?

Amir Lerman*, David R. Holmes, Joerg Herrmann and Bernard J. Gersh

Division of Cardiovascular Disease and Department of Internal Medicine, Mayo Clinic and College of Medicine, 200 First Street SW, Rochester, MN 55902, USA

Received 10 October 2006; revised 19 December 2006; accepted 4 January 2007.

* Corresponding author. Tel: +1 507 255 4152; fax: +1 507 255 2550. E-mail address: lerman.amir{at}mayo.edu

Abstract

Aims: Despite advancements over the past years, normal reperfusion at the myocardial level is not achieved in approximately every other patient with ST-elevation myocardial infarction. In the current work, we aimed at reviewing the role of the coronary microcirculation in the development and outcome of this acute coronary syndrome entity.

Methods and results: A PubMed/Medline search was performed with the key words acute coronary syndrome, acute myocardial infarction, coronary artery disease, endothelial dysfunction, microcirculation, and reperfusion. The synthesis of the information points to myocardial microcirculatory dysfunction as a consequence of a primary epicardial event, based on the vulnerable plaque concept. As an alternative theory, microcirculatory dysfunction may contribute to the clinical course of the acute coronary event, based on the vulnerable patient concept. The pros and cons of these two viewpoints are to be discussed and their influence on patient management is to be considered.

Conclusion: Microcirculatory dysfunction in ST-elevation myocardial infarction can be cause, consequence or both according to non-traditional and traditional concepts.

Key Words: Acute coronary syndrome • Myocardial infarction • Endothelium • Microcirculation


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