Potential of microvascular reperfusion with adjunctive pharmacological intervention: Its impact on myocardial perfusion and functional outcomes in patients with acute myocardial infarction

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.