Effect of No-Reflow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction on Six-Month Mortality

Brosh, David; Assali, Abid; Mager, Aviv; Porter, Avital; Hasdai, David; Teplitsky, Igal; Rechavia, Eldad; Fuchs, Shmuel; Battler, Alexander; Kornowski, Ran

doi:10.1016/j.amjcard.2006.08.054

Cited by 190 publications

(133 citation statements)

References 13 publications

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“…Bu terim ilk olarak köpeklerde, koroner ligasyonla oluşturulan miyokardiyal iskemide kullanılmıştır (17) . Akut MI'ın en korkulan komplikasyonlarından biri olarak görülen reperfüzyon hasarının, olguların %30'dan fazlasında görüldüğü ve kötü prognozla ilişkili olduğu belirtilmiştir (18) . No-refl ow'un vazoaktif birikintiler tarafından tı-kanmış mikrodamarlar ile bağlantılı olduğu düşünülmektedir.…”

Section: Akut Mi'da İskemi̇ Reperfüzyonunclassified

Ischemia-Reperfusion Injury

Songur¹

2015

Kosuyolu Heart Journal

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Genel kanı olarak, reperfüzyon hasarı, epikardial büyüme ve antegrat kan akımının normale dönmesiyle iliş-kili infarksiyon sürecinin bir bileşeni olmasına rağmen, kateterizasyon laboratuvarında, iskemi -reperfüzyon hasarı (İ/R) sık sık "no refl ow" fenomeni ile eş anlamlı olarak kullanılır. Reperfüzyon sırasında ise, iyon akışında hızlı bir değişim meydana gelir ve pH'ın normale dönüşü sırasında sitotoksisite oluşur. Na + -H + ve Na + -HCO3 + transportunu içeren Na + bağımlı pH düzenleme mekanizmaları aktive olur ki bu olay hücre içi Na + birikimine yol açar. Yüksek Na + konsantrasyonu Na + -Ca + değişimi ile intraselüler Ca + konsantrasyonunu artırır. Hücre içinde Ca +2 iyon konsantrasyonunun artışı hücre için sitotoksiktir. Kardiyak cerrahi sonucu ortaya çıkan İ/R, spontan miyokart infarktüsüne bağlı olan İ/R'den farklıdır. Cerrahi tamamlandığında kros klemp kaldırılır, kalp birden bire yüksek oranda antikoagülan içeriği olan, kardiyopulmoner baypas cihazının immünolojik etkilerine maruz kalmış ve yüksek oranda oksijen içeren kan ile reperfüze olur. Sonuç olarak, kardiyak cerrahi sonrası myokard, aşırı iskemi ve reperfüzyona maruz kalır. Klinik olarak ameliyat sonrası İ/R hasarı; aritmi, myokardiyal stunning, düşük kalp debisi veya ameliyat sonrası miyokart infarktüsü ile kendini gösterebilir. Kardiyak cerrahide kalp korunmasında en önemli köşe taşı kardiyoplejik solüsyondur. Bu solüsyon potasyum, mannitol ve glukoz içerir. Arrest edilmiş ve soğutulmuş kalpte metabolik ihtiyaçlar minimize edilmiş olur. Yıllar içinde gelişen tecrübeyle birlikte, kardiyoplejik solüsyonların içeriklerinde ufak değişiklikler meydana gelmiştir. Tüm bunlara rağmen kardiyopleji sonrası İ/R hala gözlemlenmektedir.Anahtar Kelimeler: Hasar; iskemi-reperfüzyon; açık kalp cerrahisi; miyokart Ischemia-Reperfusion Injury ABSTRACTWhile reperfusion injury is widely considered to represent a component of the infarction process related to epicardial growth and normalization of antegrade blood fl ow, the term ischemia/reperfusion (I/R) injury is frequently used synonymously with the "no refl ow" phenomenon. I/R injury after cardiac surgery is completely different from I/R injury after spontaneous myocardial infarction (MI). During reperfusion, ion transfer is rapidly altered and cytotoxicity develops as pH is normalized. Na + dependent pH regulation mechanisms such as, Na + -H + and Na + -HCO 3+ transport are activated, triggering the accumulation of intracellular Na + . Elevated intracellular Na+ levels are associated with increased intracellular Ca +2 concentrations through the activity of the Na + -Ca +2 exchanger. Elevated Ca +2 ion concentrations have a cytotoxic impact. After completion of the surgical procedure, when the cross clamp is released, the cardiac tissues are re-perfused with a highly anticoagulated and oxygenated blood, which is affected from the immunological effects of the cardiopulmonary bypass pump. Thus, after cardiac surgery myocardium is exposed to excessive ischemia and reperfusion injury that may manifest themselves as...

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Section: Akut Mi'da İskemi̇ Reperfüzyonunclassified

Ischemia-Reperfusion Injury

Songur¹

2015

Kosuyolu Heart Journal

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“…1 Tissue perfusion is also an independent predictor of mortality in STEMI patients undergoing PTCA and stenting. 3 Similarly, abnormal tissue perfusion in NSTEMI patients undergoing PCI is also associated with a higher risk of myocardial necrosis and death at 6 months and 1 year. 4 The combination of normal epicardial and tissue perfusion (angiographic perfusion score) may provide additional prognostic data.…”

Section: Measurement and Predictive Value Of Tissue Perfusion Indicesmentioning

confidence: 99%

“…2 Infarct size reduction would be expected to result in preservation of ventricular function, and this is supported by numerous studies showing improved function in the presence of preserved tissue perfusion. 3 Tissue perfusion is also an independent prognostic indicator after controlling for infarct size. Abnormal tissue perfusion correlates with abnormal left ventricular remodeling, resulting in wall thinning and dilatation, congestive heart failure (CHF), ventricular arrthymias and rupture.…”

Section: Measurement and Predictive Value Of Tissue Perfusion Indicesmentioning

confidence: 99%

Importance of Tissue Perfusion in ST Segment Elevation Myocardial Infarction Patients Undergoing Reperfusion Strategies: Role of Adenosine

Forman

Jackson

2007

Clinical Cardiology

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SummaryHigh risk ST segment elevation myocardial infarction (STEMI) patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Importantly, preclinical studies demonstrate that progressive microcirculatory failure (the "no-reflow" phenomenon) contributes significantly to myocardial reperfusion injury. Diagnostic techniques to measure tissue perfusion have validated this concept in humans, and it is now clear that abnormal tissue perfusion occurs frequently in STEMI patients undergoing reperfusion therapy. Moreover, because tissue perfusion correlates poorly with epicardial blood flow (TIMI flow grade), clinical studies show that tissue perfusion is an independent predictor of early and late mortality in STEMI patients and is associated with infarct size, ventricular function, CHF and ventricular arrhythmias. The mechanisms responsible for abnormal tissue perfusion are multifactorial and include both mechanical obstruction and vasoconstrictor humoral factors. Adenosine, an endogenous nucleoside, maintains microcirculatory flow following reperfusion by activating four well-characterized extracellular receptors. Because activation of adenosine receptors attenuates the mechanical and functional mechanisms leading to the "no reflow" phenomenon and activates other cardioprotective pathways as well, it is not surprising that both experimental and clinical studies show striking myocardial salvage with intravenous infusions of adenosine administered in the peri-reperfusion period. For example, a post hoc analysis of the AMISTAD II trial indicates a significant reduction in 1 and 6-month mortality in STEMI patients undergoing reperfusion therapy who are treated with adenosine within 3 hours of symptoms. In conclusion, adenosine's numerous cardioprotective effects, including attenuation of the "no-reflow" phenomenon, support its use in high risk STEMI undergoing reperfusion.

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“…In recent decades, despite of improving public health condition in many countries of the world, the incidence of cardiovascular diseases has become the most important health problem [1][2][3]. Returning of ST-segment is a good predictor of infarct artery patency and preserves myocardial perfusion in heart tissue level [4,5]. The successful resolution in ST-segment is as an electrocardiographic (ECG) signal of myocardial tissue repair which indicates the progression of infarction [6].…”

Section: Introductionmentioning

confidence: 99%

Evaluation clinical, electrocardiographic and laboratory response of reperfusion therapy in patients with first acute myocardial infarction

Zamani¹,

IranparvarAlamdari²,

Ashrafi³

2017

J Exp Integr Med

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Introduction: Myocardial infarction (MI) therapy is one of the most common causes of death and health issue in the world, especially in developed countries. Thrombolytic administration is a preferred life saver method of acute MI if primary angioplasty is not possible. Given that the incidence of MI in patients with metabolic syndrome, so evaluation of therapeutic response to streptokinase in this regard is very important. Methods: In this descriptive analytical study, 340 acute coronary syndrome patients which have study inclusion criteria divided randomly in two groups (with and without metabolic syndrome each with 170 patients) and collected data analyzed by statistical methods using SPSS 20. Results: Pain improvement after treatment in the group without metabolic syndrome was significantly higher than another group (58.2% vs. 23.4%) (P = 0.001). ST-segment resolution at 90 min after treatment in the group without metabolic syndrome significantly higher than another group (P = 0.002). Conclusion: Results showed that using of angioplasty is recommended as the preferred method instead of thrombolytic treatment in patients with metabolic syndrome suffering from MI.

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Effect of No-Reflow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction on Six-Month Mortality

Cited by 190 publications

References 13 publications

Ischemia-Reperfusion Injury

Ischemia-Reperfusion Injury

Importance of Tissue Perfusion in ST Segment Elevation Myocardial Infarction Patients Undergoing Reperfusion Strategies: Role of Adenosine

Evaluation clinical, electrocardiographic and laboratory response of reperfusion therapy in patients with first acute myocardial infarction

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