Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia.
Sydney Medical School, University of Sydney, Camperdown 2050, Australia.
Cells. 2021 Aug 25;10(9):2188. doi: 10.3390/cells10092188.
In acute coronary syndrome (ACS) patients, restoring epicardial culprit vessel patency and flow with percutaneous coronary intervention or coronary artery bypass grafting has been the mainstay of treatment for decades. However, there is an emerging understanding of the crucial role of coronary microcirculation in predicting infarct burden and subsequent left ventricular remodelling, and the prognostic significance of coronary microvascular obstruction (MVO) in mortality and morbidity. This review will elucidate the multifaceted and interconnected pathophysiological processes which underpin MVO in ACS, and the various diagnostic modalities as well as challenges, with a particular focus on the invasive but specific and reproducible index of microcirculatory resistance (IMR). Unfortunately, a multitude of purported therapeutic strategies to address this unmet need in cardiovascular care, outlined in this review, have so far been disappointing with conflicting results and a lack of hard clinical end-point benefit. There are however a number of exciting and novel future prospects in this field that will be evaluated over the coming years in large adequately powered clinical trials, and this review will briefly appraise these.
在急性冠状动脉综合征（ACS）患者中，通过经皮冠状动脉介入治疗或冠状动脉旁路移植术恢复心外膜罪犯血管通畅性和血流已经是治疗的主要方法已有数十年。然而，人们越来越认识到冠状动脉微循环在预测梗塞负荷和随后的左心室重构中的关键作用，以及冠状动脉微血管阻塞（MVO）在死亡率和发病率方面的预后意义。这篇综述将阐明 ACS 中 MVO 的多方面和相互关联的病理生理过程，以及各种诊断方式以及挑战，特别关注侵入性但具体和可重复的微血管阻力（IMR）指数。不幸的是，本综述中概述的针对心血管护理中这一未满足需求的众多拟议治疗策略迄今为止令人失望，结果相互矛盾，缺乏硬性临床终点获益。然而，该领域有许多令人兴奋和新颖的未来前景，将在未来几年的大型、充分有力的临床试验中进行评估，本综述将对此进行简要评价。
