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Coronary microvascular obstruction: the new frontier in cardioprotection

Basic Research in Cardiology Aims and scope Submit manuscript

Abstract

Cardioprotection aims at infarct size reduction and improvement of clinical outcome from myocardial infarction. The translation of cardioprotection from preclinical and promising proof-of-concept studies to clinical benefit for patients has been largely disappointing. Almost all of these studies which did not translate into clinical benefit had infarct size reduction as the primary endpoint and used protocols selected to achieve infarct size reduction. The present review puts forward the hypothesis that the coronary circulation is a so far neglected target of cardioprotection. Mechanisms of ischemia–reperfusion injury to the coronary circulation are detailed. Clinical methods and measures to assess coronary microvascular impairment in reperfused acute myocardial infarction are presented. A comparison of magnetic resonance imaging data on infarct size vs. coronary microvascular obstruction is made. Finally, the design of studies which are optimized not only for infarct size reduction but also for salvage of the coronary microcirculation is advocated.

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Funding

GH was supported by the German Research Foundation (SFB 1116 B8) and the European Union COST ACTION 16225.

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D. Hausenloy, Singapore, served as guest editor for the manuscript and was responsible for all editorial decisions, including the selection of reviewers. The policy applies to all manuscripts with authors from the editor’s institution.

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Heusch, G. Coronary microvascular obstruction: the new frontier in cardioprotection. Basic Res Cardiol 114, 45 (2019). https://doi.org/10.1007/s00395-019-0756-8

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