Role of Coronary Microcirculation in No-Reflow Phenomenon in Myocardial Infarction with ST Segment Elevation

The principal cause of myocardial infarction with ST segment elevation (STEMI) is thrombotic occlusion of the (epicardial) coronary artery, leading to the ischaemic myocardial necrosis. The concept of “full reperfusion” encompasses not only sufficient blood flow through epicardial coronary arteries, but also through coronary microcirculation. No-reflow, defined as low or no distal perfusion despite the removal of epicardial occlusion. The cause of this phenomena is complex and multifactorial with functional and anatomical microvascular obstruction as the common pathophysiological background. No-reflow significantly increases infarct size, LV remodelling, leading to heart failure and overall poor clinical outcomes. We present a case report of typical patient with no-reflow and summarize contemporary knowledge regarding its basic pathophysiology, clinical presentation, invasive and non-invasive diagnostic modalities, clinical consequences and basic therapeutic strategies.