Pelliccia Francesco, Niccoli Giampaolo, Zimarino Marco, Andò Giuseppe, Porto Italo, Calabrò Paolo, De Rosa Salvatore, Gragnano Felice, Piccolo Raffaele, Moscarella Elisabetta, Fabris Enrico, Montone Rocco Antonio, Spaccarotella Carmen, Indolfi Ciro, Sinagra Gianfranco, Filardi Pasquale Perrone
Department of Cardiovascular Sciences, University Sapienza, 00185 Rome, Italy.
Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy.
Rev Cardiovasc Med. 2023 Dec 25;24(12):365. doi: 10.31083/j.rcm2412365. eCollection 2023 Dec.
Primary percutaneous coronary intervention (PCI) is the current class I therapeutic approach to treat acute ST-elevation myocardial infarction (STEMI). While primary PCI can restore adequate flow in the infarcted artery in the majority of cases, some patients experience the 'no-reflow' phenomenon, i.e., an abnormal myocardial reperfusion occurring even after the occluded coronary artery has been opened. No-reflow occurs when microvascular obstruction arises from embolization of thrombus or components of the atheromatous plaques. These embolic materials travel downstream within the infarct-related artery at time of primary PCI, leading to compromised blood flow. Currently, no expert consensus documents exist to outline an optimal strategy to prevent or treat no-reflow. Interventional cardiologists frequently employ intracoronary adenosine, calcium channel blockers, nicorandil, nitroprusside or glycoprotein IIb/IIIa inhibitors. However, evidence suggests that these interventions consistently enhance myocardial blood flow in only a specific subset of patients experiencing no-reflow. A recent and innovative therapeutic approach gaining attention is low-dose fibrinolysis during primary PCI, which offers the potential to augment coronary flow post-myocardial revascularization.
直接经皮冠状动脉介入治疗（PCI）是目前治疗急性ST段抬高型心肌梗死（STEMI）的I类治疗方法。虽然在大多数情况下，直接PCI可以使梗死动脉恢复足够的血流，但一些患者会出现“无复流”现象，即即使闭塞的冠状动脉已经开通，仍会出现异常的心肌再灌注。当微血管阻塞由血栓或动脉粥样硬化斑块成分的栓塞引起时，就会发生无复流。这些栓塞物质在直接PCI时沿梗死相关动脉向下游移动，导致血流受损。目前，尚无专家共识文件概述预防或治疗无复流的最佳策略。介入心脏病学家经常使用冠状动脉内腺苷、钙通道阻滞剂、尼可地尔、硝普钠或糖蛋白IIb/IIIa抑制剂。然而，有证据表明，这些干预措施仅在特定的无复流患者亚组中持续增强心肌血流。一种最近受到关注的创新治疗方法是在直接PCI期间进行低剂量溶栓，这有可能增加心肌血运重建后的冠状动脉血流。
