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

Published: 16 August 2021

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Overview

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.
 
References
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

Andrew JS Coats

Andrew JS Coats

Professor of Cardiology and Scientific Director

Prof Coats is Editor-in-Chief of the Cardiac Failure Review journal. He has published over 20 patents, more than 750 full research papers and more than 120,000 career citations and has a personal H-index of 146. Andrew was elected to the Presidential Trio of the Heart Failure Association of the ESC in 2018 and will serve as its president from 2020-2022.

Prof Coats is the Immediate past-President of the Heart Failure Association and past-Professor of Cardiology at the University of Warwick, UK. He has also held posts as Head of Cardiology at Imperial College, London and Associate Medical Director and Director of Cardiology at the Royal Brompton and Harefield Hospitals, London. From 2012 to 2017 he was Director of the Monash-Warwick Alliance, and before that served as Deputy Vice-Chancellor and Dean of Medicine at the University of Sydney.

He is an…

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Bernard  De Bruyne

Bernard De Bruyne

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