Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Neumann, F.-J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Neumann, F.-J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Optimization of microvascular reperfusion in acute myocardial infarction

F.-J. Neumann*

Medizinische Klinik der Technischen Universität, München, Germany

* Correspondence: Franz-Josef Neumann, MD, 1 Medizinische Klinik der Technischen Universität, Ismaningerstrasse 22, 81675 München, Germany.

Abstract

Variations in flow within the spectrum of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow determine the recovery of contractile function in the infarct zone after acute myocardial infarction (MI). The limitation of microvascular reperfusion associated with such impairment may be attributable to a variety of factors, including distal embolization of small platelet aggregates and direct interactions among platelets, leukocytes and the endothelium. Activated platelets adhere to the endothelium and modulate chemotactic and adhesive properties of endothelial cells; they also bind with leukocytes and induce up-regulation of the Mac-1 integrin, promoting endothelial adherence and elaboration of inflammatory cytokines. Mac-1 activity and platelet-leukocyte interactions are increased in patients with acute MI. The platelet glycoprotein IIb/IIIa receptor inhibitor abciximab may improve microcirculatory function by reducing distal embolization of platelet aggregates and decreasing platelet leukocyte interactions. Recent studies in patients undergoing coronary stenting for acute MI have demonstrated that abciximab is associated with significant decreases in platelet leukocyte interactions and Mac-1 expression compared with standard heparin. In a randomized trial of abciximab versus standard heparin in acute MI patients undergoing stenting, abciximab treatment was associated with significant improvements in peak flow velocity and measures of contractile function, including wall motion index and numbers of hypokinetic chords in the infarct zone and global ejection fraction. These benefits were accompanied by a significant reduction in early cardiovascular events. In addition to maintaining large-vessel patency, abciximab improves recovery of microcirculatory perfusion and contractile function in acute MI.

Key Words: Acute MI • perfusion • TIMI grade 3 • abciximab • microvascular • epicardial

References

  1. Anderson JL, Karagounis LA, Becker LC, Sorensen SG, Menlove RL. TIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction: ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 study. Circulation. 1993;87:1829–1839[Abstract/Free Full Text]
  2. Reiner JS, Lundergan CF, Fung A, et al. Evolution of early TIMI 2 flow after thrombolysis for acute myocardial infarction. Circulation. 1996;94:2441–2446[Abstract/Free Full Text]
  3. Ito H, Maruyama A, Iwakura K, et al. Clinical implications of the ‘no reflow’ phenomenon: a predictor of complications and left ventricular remodeling in reperfased anterior wall myocardial infarction. Circulation. 1996;93:223–228[Abstract/Free Full Text]
  4. Neumann FJ, Kosa I, Dickfield T, et al. Recovery of myocardial perfusion in acute myocardial infarction after successful balloon angioplasty and stent placement in the infarct-related coronary artery. J Am Coll Cardiol. 1997;30:1270–1276[Abstract]
  5. Ito H, Tomooka T, Sakai N, et al. Lack of myocardial perfusion immediately after successful thrombolysis: a predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation. 1992;85:1699–1705[Abstract/Free Full Text]
  6. Komamura K, Kitakaze M, Nishida K, et al. Progressive decreases in coronary vein flow during reperfasion in acute myocardial infarction: clinical documentation of the no reflow phenomenon after successful thrombolysis. J Am Coll Cardiol. 1994;24:370–377[Abstract]
  7. Neumann F-J, Blasini R, Schmitt C, et al. Effect of glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998;98:2695–2701[Abstract/Free Full Text]
  8. Ragosta M, Camarano G, Kaul S, Powers ER, Sarembock IJ, Gimple GW. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction: new insights using myocardial contrast echocardiography. Circulation. 1994;89:2562–2569[Abstract/Free Full Text]
  9. Iliceto S, Marangelli V, Marchese A, et al. Myocardial contrast echocardiography in acute myocardial infarction: pathophysiological background and clinical applications. Eur Heart J. 1996;17:344–353[Abstract/Free Full Text]
  10. Ito H, Okamura A, Iwakura K, et al. Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation. 1996;93:1993–1999[Abstract/Free Full Text]
  11. Ishihara M, Sato H, Tateishi H, et al. Impaired coronary flow reserve immediately after coronary angioplasty in patients with acute myocardial infarction. Br Heart J. 1993;69:288–292[Abstract/Free Full Text]
  12. Davies MJ. A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation. 1990;82(Suppl II):II–38-II-46
  13. Golino P, Ashton JH, McNatt J, et al. Simultaneous administration of thromboxane A2- and serotonin S2-receptor antagonists markedly enhances thrombolysis and prevents or delays reocclusion after tissue-type plasminogen activator in a canine model of coronary thrombosis. Circulation. 1989;79:911–919[Abstract/Free Full Text]
  14. Neumann F-J, Zolnhöfer D, Fakhoury L, Ott I, Gawaz M, Schömig A. Effect of glycoprotein IIb/IIIa receptor blockade on platelet-leukocyte interaction and surface expression of the leukocyte integrin Mac-1 in acute myocardial infarction. J Am Coll Cardiol. 1999;34:1420–1426[Abstract/Free Full Text]
  15. Neumann F-J, Ott I, Gawaz M, et al. Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation. 1995;92:748–755[Abstract/Free Full Text]
  16. Gould KL, Kirkeeide RL, Buchi M. Coronary flow reserve as a physiologic measure of stenosis severity. J Am Coll Cardiol. 1990;15:459–474[Abstract]
  17. Mazur W, Bitar JN, Lechin M, et al. Coronary flow reserve may predict myocardial recovery after myocardial infarction in patients with TIMI grade 3 flow. Am Heart J. 1998;136:335–344[CrossRef][Web of Science][Medline]
  18. Gassler JP, Topol EJ. Reperfusion revisited: beyond TIMI 3 flow. Clin Cardiol. 1999;22(Suppl IV):IV–20-IV-29
  19. Akasaka T, Yoshida K, Kawamoto T, et al. Relation of phasic coronary flow velocity characteristics with TIMI perfusion grade and myocardial recovery after primary percutaneous transluminal coronary angioplasty and rescue stenting. Circulation. 2000;101:2361–2367[Abstract/Free Full Text]
  20. Gawaz M, Neumann FJ, Dickfeld T, et al. Vitronectin receptor (alpha(v)beta3) mediates platelet adhesion luminal aspect of endothelial cells: implications for reperfusion in myocardial infarction. Circulation. 1997;96:1809–1818[Abstract/Free Full Text]
  21. Gawaz M, Neumann FJ, Dickfeld T, et al. Activated platelets induce monocyte chemotactic protein-1 secretion and surface expression of intercellular adhesion molecule-1 on endothelial cells. Circulation. 1998;98:1164–1171[Abstract/Free Full Text]
  22. Kuijper PH, Gallardo Torres HI, van der Linden JA, et al. Platelet-dependent primary hemostasis promotes selectin- and integrin-mediated neutrophil adhesion to damaged endothelium under flow conditions. Blood. 1996;87:3271–3281[Abstract/Free Full Text]
  23. Ott I, Neumann FL, Gawaz M, Schmitt M, Schomig A. Increased neutrophil-platelet adhesion in patients with unstable angina. Circulation. 1996;94:1239–1246[Abstract/Free Full Text]
  24. Neumann F-J, Marx N, Gawaz M, et al. Induction of cytokine expression in leukocytes by binding of thrombin-stimulated platelets. Circulation. 1997;95:2387–2394[Abstract/Free Full Text]
  25. Simpson PJ, Todd RF III, Fantone JC, Mickelson JK, Griffin JD, Lucchesi BR. Reduction of experimental canine myocardial reperfusion injury by a monoclonal antibody (anti-Mo1, anti-CD11b) that inhibits leukocyte adhesion. J Clin Invest. 1988;81:624–629
  26. Lefer DJ, Shandelya SML, Serrano CV Jr., Becker LC, Kuppusamy P, Zweier JL. Cardioprotective actions of a monoclonal antibody against CD-18 in myocardial ischemia-reperfusion injury. Circulation. 1993;88:1779–1787 (Part 1)[Abstract/Free Full Text]
  27. Jerome SN, Smith CW, Korthuis RJ. CD18-dependent adherence reactions play an important role in the development of the no-reflow phenomenon. Am J Physiol. 1993;264:Jerome SN, Smith CW, Korthuis RJ. Heart Circ Physiol. 1993;33:H479–H483
  28. Lefer AM, Campbell B, Scalia R, Lefer DJ. Synergism between platelets and neutrophils in provoking cardiac dysfunction after ischemia and reperfusion: role of selectins. Circulation. 1998;98:1322–1328[Abstract/Free Full Text]
  29. Ott I, Neumann F-J, Kenngott S, Gawaz M, Schömig A. Procoagulant inflammatory responses of monocytes after direct balloon angioplasty in acute myocardial infarction. Am J Cardiol. 1998;82:938–942[CrossRef][Web of Science][Medline]
  30. Meisel SR, Shapiro H, Radnay J, et al. Increased expression of neutrophil and monocyte adhesion molecules LFA-1 and Mac-1 and their ligand ICAM-1 and VLA-4 throughout the acute phase of myocardial infarction: possible implications for leukocyte aggregation and microvascular plugging. J Am Coll Cardiol. 1998;31:120–125[Abstract/Free Full Text]
  31. de Lemos JA, Antman EM, Gibson CM, et al. Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction: observations from the TIMI 14 trial. Circulation. 2000;101:239–243[Abstract/Free Full Text]
  32. Neumann F-J, Kastrati A, Schmitt C, et al. Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction. J Am Coll Cardiol. 2000;35:915–921[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Neumann, F.-J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Neumann, F.-J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?