Moderate Systemic Hypotension During Reperfusion Reduces the Coronary Blood Flow and Increases the Size of Myocardial Infarction in Pigs

Nanas, John N.; Tsolakis, Elias; Terrovitis, John; Eleftheriou, Ageliki; Drakos, Stavros G.; Dalianis, Argirios; Charitos, Christos

doi:10.1378/chest.125.4.1492

Cited by 15 publications

(14 citation statements)

References 33 publications

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“…Therefore, in our study, the significant decrease in diastolic coronary resistance during reperfusion with IABP support might be attributable to the increase in DAP, which increased or even restored the flow in areas of high vascular resistance, and in low-or no-flow areas [26]. This hypothesis is supported by the severe impairment of maximum vasodilatation and coronary flow reserve observed in the acutely infarcted zone during reperfusion [27,28]. Maximum vasodilatation decreases overtime during reperfusion, along with a decrease in CBF and increase in the no-reflow phenomenon [27,29,30], suggesting that the impaired CBF reserve interferes with the autoregulatory mechanisms.…”

Section: The Effect Of Iabp On Coronary Artery Resistancesupporting

confidence: 60%

“…This hypothesis is supported by the severe impairment of maximum vasodilatation and coronary flow reserve observed in the acutely infarcted zone during reperfusion [27,28]. Maximum vasodilatation decreases overtime during reperfusion, along with a decrease in CBF and increase in the no-reflow phenomenon [27,29,30], suggesting that the impaired CBF reserve interferes with the autoregulatory mechanisms. In this study, the IABP increased the CBF during reperfusion, decreased total coronary resistance, and consistently increased CBF throughout the reperfusion period.…”

Section: The Effect Of Iabp On Coronary Artery Resistancementioning

confidence: 87%

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Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion

Bonios

Pierrakos

Argiriou

et al. 2010

International Journal of Cardiology

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Section: The Effect Of Iabp On Coronary Artery Resistancesupporting

confidence: 60%

Section: The Effect Of Iabp On Coronary Artery Resistancementioning

confidence: 87%

Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion

Bonios

Pierrakos

Argiriou

et al. 2010

International Journal of Cardiology

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“…A low SBP (\120 mmHg) decreased coronary blood flow (CBF), collateral blood flow, and increased infarct size [14,15]. Based on these data, low normal BP is associated with decreased CBF.…”

Section: Discussionmentioning

confidence: 96%

Independent no-reflow predictors in female patients with ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention

et al. 2011

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Independent no-reflow predictors should be evaluated in female patients with ST-segment elevation acute myocardial infarction (STEMI) and successfully treated with primary percutaneous coronary intervention (PPCI) in the current interventional equipment and techniques, thus to be constructed a no-reflow predicting model. In this study, 320 female patients with STEMI were successfully treated with PPCI within 12 h after the onset of AMI from 2007 to 2010. All clinical, angiographic, and procedural data were collected. Multiple logistic regression analysis was used to identify independent no-reflow predictors. The no-reflow was found in 81 (25.3%) of 320 female patients. Univariate and multivariate stepwise logistic regression analysis identified that low SBP on admission <100 mmHg (OR 1.991, 95% CI 1.018-3.896; p = 0.004), target lesion length >20 mm (OR 1.948, 95% CI 1.908-1.990; p = 0.016), collateral circulation 0-1 (OR 1.952, 95% CI 1.914-1.992; p = 0.019), pre-PCI thrombus score ≥ 4 (OR 4.184, 95% CI 1.482-11.813; p = 0.007), and IABP use before PCI (OR 1.949, 95% CI 1.168-3.253; p = 0.011) were independent no-reflow predictors. The no-reflow incidence significantly increased as the numbers of independent predictors increased [0% (0/2), 10.8% (9/84), 14.5% (17/117), 37.7% (29/77), 56.7% (17/30), and 81.8% (9/11) in female patients with 0, 1, 2, 3, 4, and 5 independent predictors, respectively; p < 0.0001]. The five no-reflow predicting variables were admission SBP <100 mmHg, target lesion length >20 mm, collateral circulation 0-1, pre-PCI thrombus score ≥ 4, and IABP use before PCI in female patients with STEMI treated with PPCI.

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“…163 In line with the hypothesis that the microvasculature becomes damaged upon reperfusion, low blood pressure is thought to lessen the risk of microvascular injury. 164,165 In experimental studies, the calcium-antagonis t diltiazem and the vasodilatory agent glyceryl trinitrate attenuated infarct size, and use of methoxamine resulted in reduced endothelial injury, and all were associated with a reduced risk of intramyocardial haemorrhage. 164,165 Aggressive reduction of blood pressure through administration of high-dose calcium antagonists, β-blockers, or angiotensin-converting-enzyme inhibitors has shown promising effects in the reduction of final infarct size.…”

Section: Reperfusion Strategiesmentioning

confidence: 99%

“…164,165 In experimental studies, the calcium-antagonis t diltiazem and the vasodilatory agent glyceryl trinitrate attenuated infarct size, and use of methoxamine resulted in reduced endothelial injury, and all were associated with a reduced risk of intramyocardial haemorrhage. 164,165 Aggressive reduction of blood pressure through administration of high-dose calcium antagonists, β-blockers, or angiotensin-converting-enzyme inhibitors has shown promising effects in the reduction of final infarct size. 2,[166][167][168][169][170][171][172] Antiplatelet therapy For the acute care of patients with STEMI, clinical guidelines recommend the periprocedural administration of dual antiplatelet therapy and to consider maintenance therapy with a glycoprotein IIb/IIIa inhibitor.…”

Section: Reperfusion Strategiesmentioning

confidence: 99%

Intramyocardial haemorrhage after acute myocardial infarction

et al. 2014

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In patients with acute myocardial infarction (AMI), the guideline-recommended treatment is mechanical revascularization by percutaneous coronary intervention (PCI), which is effective at reducing mortality. However, a substantial proportion of patients with AMI develop chronic cardiac failure owing to poor restoration of microvascular function and myocardial perfusion, despite restoration of epicardial vessel patency. This occurrence is called the 'no-reflow' phenomenon. Although pathological and clinical observations initially seemed to support the hypothesis that no-reflow was the result of microvascular obstruction, irreversible microvascular injury and subsequent intramyocardial haemorrhage are now also thought to be important factors in this process. Intramyocardial haemorrhage shares several pathophysiological features with the haemorrhagic transformation that occurs after ischaemic stroke. Understanding of the role of intramyocardial haemorrhage in the no-reflow phenomenon and myocardial injury is crucial to the development of new therapeutic strategies to treat AMI. In this Review, we provide a comprehensive overview of the pathogenesis and clinical relevance of intramyocardial haemorrhage, and discuss diagnostic options and future therapeutic strategies.

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Moderate Systemic Hypotension During Reperfusion Reduces the Coronary Blood Flow and Increases the Size of Myocardial Infarction in Pigs

Cited by 15 publications

References 33 publications

Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion

Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion

Independent no-reflow predictors in female patients with ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Intramyocardial haemorrhage after acute myocardial infarction

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