Laforgia Pietro Leonida, Auguadro Carla, Bronzato Sofia, Durante Alessandro
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Policlinico San Marco, Zingonia (BG), Milan, Italy.
Int J Prev Med. 2022 Apr 8;13:56. doi: 10.4103/ijpvm.IJPVM_122_20. eCollection 2022.
Despite the reduction of mortality secondary to cardiovascular diseases observed in the last decades, ischemic heart disease remains the most common cause of death worldwide. Among the spectrum of ischemic heart disease, myocardial infarction accounts for most deaths. Since the introduction of the coronary care units in the 1960s, and until the latest antithrombotic drugs, myocardial infarction survival improved by 40-50%. However long-term mortality after myocardial infarction has not improved as short-term mortality. Moreover, the decline of mortality has apparently reached a "plateau" in the past 15 years. In this review we describe the steps of the improvement in ischemic heart disease mortality, from the bed rest to the possible future of treating microcirculation. In fact, coronary artery disease is not only a disease of large vessels that can be visualized with coronary angiography. The small network of pre-arterioles and arterioles that supply the myocardium can be also affected in ischemic heart disease. Thus, despite the introduction of effective recanalization strategies for epicardial coronary arteries such as thrombolysis and, more recently, primary percutaneous intervention, some patients may not achieve effective myocardial reperfusion due to microvascular dysfunction or damage after myocardial myocardial infarction. This phenomenon is named no reflow. We believe that no reflow, through the incomplete reperfusion that can account for a higher rate of adverse event in the follow up, should be regarded as one of the open issues in the modern treatment of myocardial infarction.
尽管在过去几十年中观察到心血管疾病导致的死亡率有所下降，但缺血性心脏病仍然是全球最常见的死亡原因。在缺血性心脏病的范畴中，心肌梗死导致的死亡最多。自20世纪60年代引入冠心病监护病房以来，直至最新的抗血栓药物问世，心肌梗死的生存率提高了40%-50%。然而，心肌梗死后的长期死亡率并未像短期死亡率那样得到改善。此外，在过去15年中，死亡率的下降显然已达到一个“平台期”。在本综述中，我们描述了缺血性心脏病死亡率改善的各个阶段，从卧床休息到治疗微循环的可能未来。事实上，冠状动脉疾病不仅是一种能用冠状动脉造影显示的大血管疾病。供应心肌的小动脉前支和小动脉网络在缺血性心脏病中也可能受到影响。因此，尽管已经引入了有效的冠状动脉再通策略，如溶栓治疗以及最近的直接经皮冠状动脉介入治疗，但由于心肌梗死后微血管功能障碍或损伤，一些患者可能无法实现有效的心肌再灌注。这种现象被称为无复流。我们认为，无复流通过不完全再灌注导致随访中不良事件发生率较高，应被视为现代心肌梗死治疗中的一个未解决问题。
