{"id":"ea5f9a667472","type":"article","url":"https://hartvaat.nl/2026/05/26/esc-consensusverklaring-over-microvasculaire-obstructie-en-no-reflow-na-stemi/","title":"ESC-consensusverklaring over microvasculaire obstructie en no-reflow na STEMI","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","biomarkers-cardiovasculair","bloeddrukbehandeling","endotheel","farmaco-economie","hartrevalidatie","laminopathie","microcirculatie","niet-statine-therapie","ouderen","richtlijnen-esc","secundaire-preventie","slaapapneu","stabiel-coronairlijden"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag334","source_url":"https://doi.org/10.1093/eurheartj/ehag334","authors":["Edina Cenko","Lina Badimon","Giuseppe Vadalà","Daphne Merkus","Charalambos Antoniades","Carlos Collet","Giovanni Luigi De Maria","Ana Djordjevic-Dikic","Ines Drenjancevic","Javier Escaned","José Luis Ferreiro","Ingrid Fleming","Tomasz Guzik","Olivia Manfrini","Davor Milicic","Teresa Padro","Italo Porto","Laurent Marc Riou","Nicola Ryan","Dimitris Tousoulis","Heleen M M van Beusekom","Marija Vavlukis","Gemma Vilahur","Marija Zdravkovic","Dirk J Duncker","Alfredo Ruggero Galassi","Raffaele Bugiardini"],"significance":8,"published":"2026-05-29","source_date":"2026-05-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/ischemie-reperfusieschade/"],"congress":"","summary_en":"Clinical consensus statement on the pathophysiology, prevention, and management of microvascular obstruction ('no-reflow') after primary PCI in STEMI. Despite timely revascularization, suboptimal myocardial reperfusion persists in up to 60% of cases, with major risk of adverse LV remodeling, heart failure and death. Pharmacological therapies (intracoronary adenosine, nitroprusside) show unclear benefit. Non-pharmacological strategies — ischemic postconditioning, supersaturated oxygen therapy, mechanical LV unloading — show promise but require large-scale RCT validation. The statement underscores the need for better risk stratification and novel microvasculature-targeted therapies.","created":"2026-07-03T10:32:57Z","updated":"2026-07-03T18:39:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Klinische consensusverklaring over pathofysiologie, preventie en behandeling van microvasculaire obstructie ('no-reflow') na primaire PCI bij STEMI. Ondanks tijdige revascularisatie blijft suboptimale myocardiale reperfusie aanwezig bij tot 60% van de patiënten, met sterk verhoogd risico op nadelige LV-remodeling, hartfalen en overlijden. Farmacologische strategieën (intracoronaire adenosine, nitroprusside) tonen onduidelijk voordeel. Niet-farmacologische opties zoals ischemische postconditionering, intracoronaire supersaturated oxygen-therapie en mechanische LV-unloading zijn veelbelovend maar vragen om grootschalige RCT's. Het document onderstreept de noodzaak van betere risicostratificatie en microvasculatuur-gerichte therapieën.","abstract_original":"Although prompt primary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-elevation myocardial infarction (STEMI), the burden of post-infarction heart failure remains considerable and is expected to increase. A major contributory factor is suboptimal myocardial reperfusion, which persists in up to 60% of cases even with timely revascularization. This is largely driven by microvascular obstruction and ischaemia-reperfusion injury, culminating in the no-reflow phenomenon, a critical prognostic factor associated with impaired infarct healing, adverse left ventricular remodelling, and increased risk of heart failure and death. No-reflow is a complex and heterogeneous phenomenon, identifiable through different invasive and noninvasive technologies. When observed post-PCI, after excluding residual epicardial stenosis, it indicates poor microvascular perfusion and necessitates urgent management. Identifying patients at high risk and implementing early targeted interventions are essential to improving outcomes. Pharmacological therapies, including intracoronary adenosine and nitroprusside, have shown unclear benefit in improving microvascular flow. Non-pharmacological strategies, such as ischaemic postconditioning, intracoronary supersaturated oxygen therapy, stent-retriever thrombectomy, and mechanical left ventricular unloading, have demonstrated promise but require further validation in large-scale clinical trials. This clinical consensus statement summarizes current strategies for the prevention and treatment of no-reflow and underscores the need for improved risk stratification and novel microvasculature-targeted therapies. Addressing this persistent and significant unmet clinical need is crucial for improving care for STEMI patients and for mitigating its long-term complications, including heart failure and mortality."}