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ST-segment elevation myocardial infarction (STEMI) treatment with primary percutaneous coronary intervention has dramatically impacted prognosis. However, despite satisfactory angiographic result, occurrence or persistence of coronary microvascular dysfunction after revascularization still affects long-term outcomes. The diagnostic and therapeutic value of understanding the status of coronary microcirculation is gaining attention in the cardiology community. However, current methods to assess microvascular function (namely, cardiac magnetic resonance and invasive wire-based coronary physiology) remain, at least in part, limited by technical and logistic aspects. On the other hand, angiography-based indices of microcirculatory resistance are emerging as valid and user-friendly tools with potential impact on prognostic stratification of patients with STEMI. This review provides an overview about conventional and novel methods to assess coronary microvascular dysfunction in patients with STEMI. The authors also provide a proposed procedural algorithm to facilitate optimal use of wire-based and angiography-based indices in the acute setting of STEMI.

Original publication




Journal article


JACC Cardiovasc Imaging

Publication Date





965 - 981


STEMI, acute coronary syndrome, acute myocardial infarction, angiography-derived index of microcirculatory resistance, coronary microvascular dysfunction, index of microcirculatory resistance, Humans, ST Elevation Myocardial Infarction, Coronary Vessels, Coronary Circulation, Microcirculation, Predictive Value of Tests, Myocardial Infarction, Coronary Angiography, Percutaneous Coronary Intervention, Treatment Outcome