Optimal therapeutic strategies in the setting of post-infarct no reflow: the need for a pathogenetic classification

摘要

Although no reflow is clearly associated with a poor prognosis, little guidance is available on the treatment of this phenomenon. The ideal therapeutic approach comprises drugs with multiple actions on the microvascular damage produced by ischaemia/reperfusion, as well as knowledge of the time course of events in order to optimise the timing of administration Extensively studied both in the experimental and clinical setting, the no reflow phenomenon is clearly associated with unfavourable clinical outcome and prognosis. Despite the large body of evidence on the efficacy of different possible therapeutic approaches, clear guidelines on the treatment of no reflow have not been given; thus, the phenomenon is not consistently and uniformly treated in clinical practice. A possible reason for this apparent paradox may reside in the confusion generated by the multi-factorial pathogenesis of no reflow, with consequent difficulty in the design of an adequate therapeutic strategy. Thus, there is a need for a pathogenetic classification of the phenomenon as an important premise for targeted forms of treatment.