Nicolau Andre M, Silva Pedro G, Mejía Hernan Patricio G, Granada Juan F, Kaluza Grzegorz L, Burkhoff Daniel, Abizaid Thiago, Pileggi Brunna, Freire Antônio F D, Godinho Roger R, Campos Carlos M, de Brito Fabio S, Abizaid Alexandre, Melo Pedro H C
Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo (InCor/HCFMUSP), São Paulo 05403-900, Brazil.
Cardiovascular Research Foundation, New York, NY 10019, USA.
Int J Mol Sci. 2025 Jul 16;26(14):6835. doi: 10.3390/ijms26146835.
Coronary microvascular obstruction and dysfunction (CMVO) frequently arise following primary percutaneous coronary intervention (PCI), particularly in individuals with myocardial infarction. Despite the restoration of epicardial blood flow, microvascular perfusion might still be compromised, resulting in negative clinical outcomes. CMVO is a complex condition resulting from a combination of ischemia, distal thrombotic embolization, reperfusion injury, and individual susceptibilities such as inflammation and endothelial dysfunction. The pathophysiological features of this condition include microvascular spasm, endothelial swelling, capillary plugging by leukocytes and platelets, and oxidative stress. Traditional angiographic assessments, such as Thrombolysis in Myocardial Infarction (TIMI) flow grade and myocardial blush grade, have limited sensitivity. Cardiac magnetic resonance imaging (CMR) stands as the gold standard for identifying CMVO, while the index of microvascular resistance (IMR) is a promising invasive option. Treatment approaches involve powerful antiplatelet drugs, anticoagulants, and supersaturated oxygen, yet no treatment has been definitively shown to reverse established CMVO. CMVO remains a significant therapeutic challenge in coronary artery disease management. Enhancing the comprehension of its core mechanisms is vital for the development of more effective and personalized treatment strategies.
冠状动脉微血管阻塞和功能障碍（CMVO）在初次经皮冠状动脉介入治疗（PCI）后经常出现，尤其是在心肌梗死患者中。尽管心外膜血流得以恢复，但微血管灌注仍可能受损，从而导致不良临床结局。CMVO是一种复杂的病症，由缺血、远端血栓栓塞、再灌注损伤以及个体易感性（如炎症和内皮功能障碍）共同引起。该病症的病理生理特征包括微血管痉挛、内皮肿胀、白细胞和血小板导致的毛细血管堵塞以及氧化应激。传统的血管造影评估，如心肌梗死溶栓（TIMI）血流分级和心肌造影剂增强分级，敏感性有限。心脏磁共振成像（CMR）是识别CMVO的金标准，而微血管阻力指数（IMR）是一种有前景的有创检查方法。治疗方法包括强效抗血小板药物、抗凝剂和超饱和氧，但尚无明确证据表明哪种治疗方法能逆转已形成的CMVO。CMVO仍然是冠状动脉疾病管理中的一项重大治疗挑战。加强对其核心机制的理解对于制定更有效和个性化的治疗策略至关重要。
