Coronary Microvascular Dysfunction: A Peer-to-Peer Series on Improving Outcomes Post Primary-PCI

Published: 16 August 2021

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Full programme

Part 4 of 6

Restoring Viable Microcirculation — Part A

Gregg Stone, Adrian P Banning


This peer-to-peer series is dedicated to evaluating microvascular dysfunction following myocardial infarction – an important cause of mortality and morbidity post primary-PCI.
Although epicardial coronary blood flow is restored after almost all PCI procedures, perfusion of the coronary microvasculature is not fully restored in approximately half of patients. In this series of bitesize interviews, Prof Gregg Stone (Professor of Medicine, Professor of Population Health Sciences and Policy, and Director of Academic Affairs, Mount Sinai) examines this unmet need with help from a celebrated faculty of experts. Together, they will be covering everything from pathophysiology of microvascular dysfunction to current approaches to restoring microvascular perfusion post primary-PCI.
These shorter videos are ideal for those who are time-poor, or prefer to consume their education in short chunks. Don’t miss this unique overview from some of the world’s leading experts.
Cohen M, Boiangiu C, Abidi M. Therapy for ST-segment elevation myocardial infarction patients who present late or are ineligible for reperfusion therapy. J Am Coll Cardiol 2010;55:1895–1906.

This peer-to-peer series is supported from an unrestricted educational grant by

Key Learning Objectives

  • Recall residual mortality and morbidity associated with infarct size and microvascular dysfunction following AMI/STEMI
  • Describe the relationship between infarct size, microvascular dysfunction and long-term outcomes AMI/STEMI patients
  • Describe the pathological processes underlying microvascular dysfunction following AMI/STEMI
  • List the clinical presentation features, biomarkers and imaging parameters associated with microvascular obstruction following AMI/STEMI
  • Select suitable management approaches for minimising infarct size and microvascular damage in individuals requiring reperfusion

Target Audience

  • Interventional Cardiologists
  • General Cardiologists
  • Imaging Specialists

More from this programme

Part 1

Morbidity of Patients Post AMI/STEMI

In part A, Prof Gregg Stone and Prof Colin Berry explore why we see such a notable lack of myocardial salvage after primary PCI and how microvascular dysfunction impacts patient outcomes. In part B, Prof Gregg Stone and Prof Colin Berry consider the importance of infarct size and microvascular obstruction on patient outcomes.

Part 2

Microcirculation and Microvascular Obstruction Post AMI/STEMI and its Relation to Infarct Size

In this video, Prof Gregg Stone and Prof Margaret McEntegart discuss the relationship between infarct size and the degree of microvascular dysfunction.

Part 3

Mechanisms of Microvascular Dysfunction and Reperfusion Injury

In this extended video, Prof Gregg Stone speaks with Dr Michael Gibson about reperfusion injury – the causes of it and its role in preventing blood flow to the myocardium. They also discuss common methods to assess the extent and complexity of infarct following PCI.

Part 4

Current Approaches for Restoring Viable Microcirculation

In part a, Prof Gregg Stone and Prof Adrian Banning discuss the current approaches in restoring viable microcirculation highlighting which pharmacological approaches play a role and discussing the two main device-based strategies. In part b, Prof Gregg Stone and Prof Adrian Banning discuss where the warning signs will be and how IMR will differ between patients.

Part 5

Process of Microvascular Dysfunction

In this video, Prof Gregg Stone and Dr Bernard De Bruyne evaluate the prognosis and discuss particular features that put STEMI at increased risk post primary PCI.

Part 6

Process of Microvascular Dysfunction

In this final video, Prof Gregg Stone and Dr Bernard De Bruyne discuss the process of microvascular obstruction and why the fusion to the microvascular might not be present after primary PCI.

Faculty Biographies

Gregg Stone

Gregg Stone

Professor of Medicine, Professor of Population Health Sciences and Policy, and Director of Academic Affairs

Dr Stone is a leading expert in interventional cardiology and is one of the most widely cited researchers in science. He has served as the principal investigator for approximately 130 national and international multicentre randomised trials, has delivered thousands of lectures internationally, and has authored more than 2,500 book chapters, manuscripts and abstracts published in peer-reviewed literature.

Dr Stone is the Director of Academic Affairs for Mount Sinai Heart Health System, and Professor of Medicine and Professor of Population Health Sciences and Policy at The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine, at Mount Sinai, New York.

Dr Gregg Stone is an editorial board member of Interventional Cardiology: Reviews, Research, Resources (ICR3).

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Adrian P Banning

Adrian P Banning

Dr Adrian Banning is a consultant cardiologist specialising in percutaneous coronary intervention.

He is the president of the British Cardiac Intervention Society and was previously the Divisional Director for Cardiology, Cardiothoracic and Vascular Surgery at the John Radcliffe University Hospital, Oxford. Through his position at the John Radcliffe, and his own practice at Oxford’s The Manor Hospital, Prof Banning provides specialist regional services for coronary and valvular heart disease patients to an area of 1.2 million people.

Prof Banning is pioneering research in his field and lectures nationally and internationally. He has authored several books on coronary intervention and has more than 300 PubMed listed scientific papers to his name.

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