Microvascular dysfunction following primary percutaneous coronary intervention in the setting of ST-elevation myocardial infarction

Primary percutaneous coronary intervention (PCI) is an established reperfusion strategy in the treatment of acute myocardial infarction with ST-segment elevation (STEMI). Nevertheless, myocardial damage is not terminated immediately, even with successful primary PCI, which eliminates the epicardial occlusion. Despite the success of contemporary reperfusion therapy and effective restoration of epicardial coronary flow, many patients have suboptimal flow at the tissue level within the myocardium. Studies indicate that these patients have a decreased recovery of left ventricular function and poor long-term prognosis. This could be due to reperfusion injury, embolization of epicardial thrombus or plaque debris jeopardizing tissue-level perfusion. This article attempts to review the process of microvascular dysfunction following reperfusion of STEMI with primary PCI and different strategies tried thus far to improve this.