• MRI
• coronary stenting
• acute coronary syndrome

Primary percutaneous coronary intervention (PPCI) can help preserve function and save lives. In developed countries, it is used as the primary therapeutic approach in patients with acute coronary syndrome. It may be difficult to appropriately select patients for early intervention, especially when they present late.

Late myocardial reperfusion may lead to complications related to reperfusion injury. Because endothelial cells are much more resistant to ischaemia, the most important difference between early and late revascularisation is the presence of endothelial damage in prolonged ischaemic injury. Thus, reperfusion of vessels with then damaged, leaky endothelium, leads to extravasation of blood. Unfortunately, extravascular blood is a strong trigger for inflammation, associated with oedema and (expanding) necrosis. As a consequence, microvascular obstruction reflects severe microvascular injury with progressive myocardial damage.1 Unfortunately, myocardial haemorrhage has been completely neglected, simply because there were no appropriate in vivo tests.

In this issue of Heart, Mather et al2 present data on the impact of myocardial haemorrhage on functional outcome (see page 453). Consistent with previous knowledge about the devastating consequences of haemorrhage for the myocardium, the presence of haemorrhage was the strongest predictor of numerous markers of worse functional outcome as determined after 3 months. As expected, …