The myocardial microcirculation: A key target for salvaging ischemic myocardium?

Clinical management of patients with acute myocardial infarction for the most part involves re-opening of an infarct-related coronary vessel by the use of clot-busting pharmacologic treatment or percutaneous coronary interventions. While blood flow in the epicardial coronary vessel is restored downstream, effects remain largely unexplored; progressive injury at the microvessel level has significant repercussions on restoration of cardiocyte viability and the ventricular blood flow and contractile function relationship. This review focuses on the cardiac microcirculation and the fact that it should be a principle target of future studies to permit improvement of clinical outcomes in patients presenting with evolving myocardial infarction.