, Volume 61, Issue 4, pp 437–441 | Cite as

Potential of Microvascular Reperfusion with Adjunctive Pharmacological Intervention

Its Impact on Myocardial Perfusion and Functional Outcomes in Patients with Acute Myocardial Infarction
  • Yoshiaki Taniyama
  • Hiroshi Ito
  • Ryuichi Morishita
  • Toshio Ogihara
Leading Article


One of the major limitations of reperfusion therapy in acute myocardial infarction (AMI) is the presentation of no-reflow phenomenon. In 25 to 30% of patients with AMI, myocardial blood flow is occasionally profoundly reduced, even after coronary recanalisation, because of microvascular dysfunction - so-called no-reflow phenomenon. Patients with this phenomenon are regarded as a high risk group among patients with reperfused AMI.

Clinical studies using myocardial contrast echocardiography have demonstrated that intracoronary injection of calcium antagonists or potassium channel agonists in conjunction with coronary reperfusion can augment myocardial blood flow and that this was associated with better functional and clinical outcomes than with percutaneous transluminal coronary angioplasty alone. Thus, it is possible to prevent reperfusion injury and improve cardiac function using a adjunctive pharmacological intervention, either intravenously or by infusion directly into the coronary artery.


Acute Myocardial Infarction Myocardial Blood Flow Abciximab Nicorandil Microvascular Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hillis LD, Former S, Braunwald E. Risk stratification before thrombolytic therapy in patients with acute myocardial infarction. J Am Coll Cardiol 1990; 16: 313–5PubMedCrossRefGoogle Scholar
  2. 2.
    Gruppo Italiano per lo Studio Delia Streptkinesi Nell E Infarct (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; I: 397–401Google Scholar
  3. 3.
    Kennedy JW, Ritchie JL, Davis KB, et al. Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. N Engl J Med 1983; 309: 1477–82PubMedCrossRefGoogle Scholar
  4. 4.
    Bates ER, Krell MJ, Dean EN, et al. Demonstration of ‘no reflow’ phenomenon by digital coronary angiography. Am J Cardiol 1986; 57: 177–8PubMedCrossRefGoogle Scholar
  5. 5.
    Jeremy RW, Links JM, Becker CC. Progressive failure of coronary flow during reperfusion of myocardial infarction: documentation of the no reflow phenomenon with positron emission tomography. J Am Coll Cardiol 1990; 16: 695–704PubMedCrossRefGoogle Scholar
  6. 6.
    Feld H, Lichsten E, Schachter J, et al. Early and late angiographic findings of ‘no reflow’ phenomenon following direct angioplasty as primary treatment for acute myocardial infarction. Am Heart J 1992; 123(3): 782–4PubMedCrossRefGoogle Scholar
  7. 7.
    Ito H, Tomooka T, Sakai N, et al. Lack of myocardial perfusion immediately after successful thrombolysis: predicator of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 1992; 85: 1699–705PubMedCrossRefGoogle Scholar
  8. 8.
    Ito H, Iwakura K, Oh H, et al. Temporal changes in myocardial perfusion patterns in patients with reperfused anterior wall myocardial infarction: their relation to myocardial viability. Circulation 1995; 91: 656–62PubMedCrossRefGoogle Scholar
  9. 9.
    Ito H, Okamura A, Iwakura K, et al. Myocardial perfusion patterns related to thrombolysis in myocardial infarction grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation 1996; 93: 1993–9PubMedCrossRefGoogle Scholar
  10. 10.
    Ito H, Maruyama A, Iwakura K, et al. Clinical implications of ‘no reflow’ phenomenon: a predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 1996; 93: 223–8PubMedCrossRefGoogle Scholar
  11. 11.
    Lepper W, Hoffmann R, Kamp O, et al. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angiography in patients with acute myocardial infarction. Circulation 2000 May 23; 101(20): 2368–74PubMedCrossRefGoogle Scholar
  12. 12.
    Stahl LD, Aversano TR, Becker LC. Selective enhancement of function of stunned myocardium by increased flow. Circulation 1986; 74: 843–51PubMedCrossRefGoogle Scholar
  13. 13.
    Babbit DG, Virmani R, Forman MB. Intracoronary adenosine administrated after reperfusion limits vascular injury after prolonged ischemia in the canine model. Circulation 1989; 80: 1388–99CrossRefGoogle Scholar
  14. 14.
    Mahaffey KW, Puma JA, Barbagelata A, et al. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomised, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J Am Coll Cardiol 1999; 34(6): 1711–20PubMedCrossRefGoogle Scholar
  15. 15.
    Marzilli M, Orsini E, Marraccini P, et al. Beneficial effect of intracoronary adenosine as adjunct to primary angioplasty in acute myocardial infarction. Circulation 2000; 101(18): 2154–9PubMedCrossRefGoogle Scholar
  16. 16.
    Theroux P, Gregorie J, Chin C, et al. Intravenous diltiazem in acute myocardial infarction: diltiazem as adjunctive therapy to active (DATA) trial. J Am Coll Cardiol 1998; 32(3): 620–8PubMedCrossRefGoogle Scholar
  17. 17.
    Piana RN, Paik GY, Mosucci M, et al. Incidence and treatment of ‘no reflow’ after percutaneous coronary intervention. Circulation 1994; 89: 2514–8PubMedCrossRefGoogle Scholar
  18. 18.
    Taniyama Y, Ito H, Iwakura K, et al. Beneficial effect of intracoronary verapamil on microvascular salvage in patients with acute myocardial infarction. J Am Coll Cardiol 1997; 30: 1193–9PubMedCrossRefGoogle Scholar
  19. 19.
    Kitakaze M, Minamino T, Node K, et al. Role of activation of ectopic 5’-nucleotidase in the cardioprotection mediated by opening K+ channel. Am J Physiol 1995; 26: 477–84Google Scholar
  20. 20.
    Sakata Y, Kodama K, Komamura K, et al. Salutary effect of adjunctive intracoronary nicorandil administration on restoration of myocardial blood flow and functional improvement in patients with acute myocardial infarction. Am Heart J 1997; 133: 616–21PubMedCrossRefGoogle Scholar
  21. 21.
    Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol 1999; 33: 654–60PubMedCrossRefGoogle Scholar
  22. 22.
    Villaneuva FS, Glasheen WP, Kaul S, et al. Characterization of spatial patterns of flow within the reperfused myocardium by myocardial contrast echocardiography: implication in determining extent of myocardial salvage. Circulation 1993; 88: 2596–606CrossRefGoogle Scholar
  23. 23.
    Rawischer D, Levin TN, Cohen I, et al. Rapid reversal of noreflow using abciximab after coronary device intervention. Cathet Cardiovasc Diagn 1997; 41: 187–90CrossRefGoogle Scholar
  24. 24.
    Brener SJ, Barr LA, Burchenal JE, et al. Effect of abciximab on the pattern of reperfusion in patients with acute myocardial infarction treated with primary angioplasty: RAPPORT investigators. ReoPro and primary PTCA organization and randomized trial. J Am Coll Cardiol 1999; 84(6): 728–30, A8Google Scholar
  25. 25.
    Woods KL, Fletcher S, Roffe C, et al. Intravenous magnesium sulphate in suspected acute myocardial infarction: result of second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1992; 339: 1553–9PubMedCrossRefGoogle Scholar
  26. 26.
    Woods KL, Fletcher S. Long-term outcomes after intravenous magnesium sulphate in suspected acute myocardial infarction: the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1994; 343: 816–9PubMedCrossRefGoogle Scholar
  27. 27.
    ISIS collaborate groups. ISIS-4: randomized study of intravenous magnesium in over 50,000 patients with suspected acute myocardial infarction. Lancet 1995; 345: 669–85CrossRefGoogle Scholar
  28. 28.
    Herog WR, Schoolbag ML, MacMurdy K, et al. Timing of magnesium therapy affects experimental infarct size. Circulation 1995; 92: 2622–6CrossRefGoogle Scholar
  29. 29.
    Forman MB, Perry JM, Wilson BH, et al. Demonstration of myocardial reperfusion injury in humans: result of a pilot study utilizing acute coronary angioplasty with perfluorochemical emulsion in the treatment of myocardial reperfusion injury. Am Heart J 1992; 124: 1347–57PubMedCrossRefGoogle Scholar
  30. 30.
    Buerke M, Rupprecht HJ, vom Dahl J, et al. Sodium-hydrogen exchange inhibition: novel strategy to prevent myocardial injury following ischemia and reperfusion. Am J Cardiol 1999; 83(10A): 19G–22GPubMedCrossRefGoogle Scholar
  31. 31.
    Rupprecht HJ, Dahl JV, Terres W, et al. Cardioprotective effects of the Na (+9)/H (+) exchange inhibitor cariporide in patients with acute anterior myocardial infarction undergoing direct PTCA. Circulation 2000; 101(25): 2902–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • Yoshiaki Taniyama
    • 1
    • 2
  • Hiroshi Ito
    • 3
  • Ryuichi Morishita
    • 2
  • Toshio Ogihara
    • 2
  1. 1.Cardiovascular ResearchSt Elizabeth’s Medical CenterBostonUSA
  2. 2.Department of Geriatric MedicineOsaka University Graduate School of MedicineSuitaJapan
  3. 3.Division of CardiologySakurabashi Watanabe HospitalOsakaJapan

Personalised recommendations