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Successful restoration of epicardial coronary blood flow can be achieved in over 95% of PCI procedures. However, despite angiographically complete epicardial coronary artery patency, in about half of the patients perfusion to the distal coronary microvasculature is not fully restored, which is associated with increased morbidity and mortality. The exact pathophysiological mechanism of post-ischaemic coronary microvascular dysfunction (CMD) is still debated. Therefore, the current review discusses invasive and non-invasive techniques for the diagnosis and quantification of CMD in STEMI in the clinical setting as well as results from experimental in vitro and in vivo models focusing on ischaemic-, reperfusion-, and inflammatory damage to the coronary microvascular endothelial cells. Finally, we discuss future opportunities to prevent or treat CMD in STEMI patients.<\/jats:p>","DOI":"10.1093\/cvr\/cvz301","type":"journal-article","created":{"date-parts":[[2019,11,6]],"date-time":"2019-11-06T15:10:03Z","timestamp":1573053003000},"page":"787-805","source":"Crossref","is-referenced-by-count":246,"title":["Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2634-2864","authenticated-orcid":false,"given":"Lara S F","family":"Konijnenberg","sequence":"first","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Damman","sequence":"first","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2836-2241","authenticated-orcid":false,"given":"Dirk J","family":"Duncker","sequence":"first","affiliation":[{"name":"Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Kloner","sequence":"first","affiliation":[{"name":"Huntington Medical Research Institutes, Pasadena, CA, USA"},{"name":"Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Nijveldt","sequence":"first","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert-Jan M","family":"van Geuns","sequence":"first","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4547-8636","authenticated-orcid":false,"given":"Colin","family":"Berry","sequence":"first","affiliation":[{"name":"West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK"},{"name":"British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels P","family":"Riksen","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The 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