Ciofani Jonathan L, Allahwala Usaid K, Scarsini Roberto, Ekmejian Avedis, Banning Adrian P, Bhindi Ravinay, De Maria Giovanni Luigi
Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK.
Future Cardiol. 2021 Mar;17(2):383-397. doi: 10.2217/fca-2020-0077. Epub 2020 Sep 11.
Improvements in systems, technology and pharmacotherapy have significantly changed the prognosis over recent decades in patients presenting with ST-segment elevation myocardial infarction. These clinical achievements have, however, begun to plateau and it is becoming increasingly necessary to consider novel strategies to further improve outcomes. Approximately a third of patients treated by primary percutaneous coronary intervention for ST-segment elevation myocardial infarction will suffer from coronary no-reflow (NR), a condition characterized by poor myocardial perfusion despite patent epicardial arteries. The presence of NR impacts significantly on clinical outcomes including left ventricular dysfunction, heart failure and death, yet conventional management algorithms neither assess the risk of NR nor treat NR. This review will provide a contemporary overview on the pathogenesis, diagnosis and treatment of NR.
近几十年来，系统、技术和药物治疗方面的进步显著改变了ST段抬高型心肌梗死患者的预后。然而，这些临床成果已开始趋于平稳，因此越来越有必要考虑采用新策略以进一步改善治疗效果。接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中，约三分之一会发生冠状动脉无复流（NR），这种情况的特征是尽管心外膜动脉通畅，但心肌灌注不良。NR的存在对包括左心室功能障碍、心力衰竭和死亡在内的临床结局有显著影响，然而传统的管理算法既不评估NR风险，也不治疗NR。本综述将对NR的发病机制、诊断和治疗进行当代概述。
