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(Circulation. 2000;101:e87.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

-Adrenergic Blockade in Myocardial Infarction

H. Richard Hellstrom, MD

Department of Pathology Health Science Center at Syracuse, State University of New York, Syracuse, NY

	Introduction

 
To the Editor:

I read with interest the article by Gregorini et al¹ that showed that -adrenergic blockade improves recovery of myocardial perfusion and function after stenting in acute myocardial infarction (AMI), and I suggest that this finding can be explained by a basic principle of the spasm of resistance vessel (S-RV) concept of ischemic heart disease (IHD), a theory that asserts that S-RV induces symptoms in IHD.²

A basic premise of the concept is that severe ischemic injury is a major cause of S-RV, and it is known that injury incites S-RV.³ It seems reasonable that stenotic coronary artery disease (CAD) can cause sufficient ischemic injury to induce ischemic injury–induced (II-I) S-RV, and the concept attributes effort angina to II-I S-RV; however, other vasoconstrictive forces, such as emotional stress, can also be operative. The severe necrotic injury of AMI is considered to cause continuing II-I S-RV and no-reflow (reduced myocardial perfusion),² and the reduced perfusion studied by Gregorini et al¹ is regarded as no-reflow. In keeping with these positions, there is evidence for both ischemic- and injury-induced coronary S-RV,² and no-reflow has recently been attributed to S-RV by others.⁴

II-I S-RV is regarded as an expression of the hemostatic response, which is a basic defensive or homeostatic mechanism designed to prevent exsanguination after injury.³ Hemostasis includes initial vasoconstriction and subsequent thrombosis, but local thromboses would not be expected with ischemic injury because, unlike the usual injury, vascular disruption does not occur; however, no-reflow secondary to S-RV is assumed to . . . [Full Text of this Article]

Luisa Gregorini, MD; Gian Battista Anguissola, MD

Milano, Italy

Jean Marco, MD; Isabelle Marco, MD; Monoiques Bernies, MD; Bernard Cassagneau, MD; Irene M. Bossi, MD; Jean Fajadet, MD; Toulouse France; Michaela Kozàkovà; Carlo Palombo, MD; Alessandro Distante, MD

Pisa, Italy

Gerd Heusch, MD

Essen, Germany