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  • Review Article
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Targeting angiogenesis to restore the microcirculation after reperfused MI

Nature Reviews Cardiology volume 6, pages 515–523 (2009)Cite this article

Abstract

Since early reperfusion therapy for patients with acute myocardial infarction (AMI) was demonstrated to decrease mortality, numerous improvements in AMI management have focused on prompt reperfusion of the epicardial coronary arteries. However, in a substantial group of patients with AMI, reperfusion of the myocardial tissue is hindered by dysfunction of the microvasculature, despite successful restoration of the epicardial coronary flow. These patients have prolonged ischemia and an adverse clinical outcome. Although several studies investigating the etiology of microvascular dysfunction have been performed, little is known about the restoration process of microvascular dysfunction after reperfused AMI. The objective of this Review is to summarize our knowledge on natural restoration of the microvasculature after reperfused AMI, particularly with regard to angiogenesis, discuss diagnostic modalities used to identify patients with microvascular dysfunction and highlight the potential of pharmacological and cellular interventions to stimulate the recovery of the microvasculature by promoting angiogenesis.

Key Points

  • Despite successful primary percutaneous coronary intervention, a large proportion of patients with acute myocardial infarction show inadequate myocardial perfusion, owing to dysfunction of the microcirculation

  • Microvascular dysfunction is associated with an adverse clinical outcome

  • Tissue edema, vasoconstriction, endothelial cell swelling, inflammation, neutrophil plugging and the embolization of atheromatous and thrombotic debris are all causes of microvascular dysfunction

  • Damaged microvasculature can be restored by angiogenesis

  • Several growth factors and circulating mononuclear cells, including bone marrow mononuclear cells, are involved in the process of angiogenesis

  • Targeting angiogenesis constitutes a potential new treatment modality to counteract the negative effects of microvascular dysfunction after mechanically reperfused myocardial infarction

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Figure 1: Pathophysiology and restoration of microvascular dysfunction.

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  1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Anja M. van der Laan, Jan J. Piek & Niels van Royen

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van der Laan, A., Piek, J. & van Royen, N. Targeting angiogenesis to restore the microcirculation after reperfused MI. Nat Rev Cardiol 6, 515–523 (2009). https://doi.org/10.1038/nrcardio.2009.103

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