Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention |
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Authors: | Wilson Mathias Jeane M Tsutsui Bruno G Tavares Agostina M Fava Miguel OD Aguiar Bruno C Borges Mucio T Oliveira Alexandre Soeiro Jose C Nicolau Henrique B Ribeiro Hsu Po Chiang João CN Sbano Abdulrahman Morad Andrew Goldsweig Carlos E Rochitte Bernardo BC Lopes José AF Ramirez Roberto Kalil Filho Thomas R Porter |
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Institution: | 1. Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil;2. University of Nebraska Medical Center, Omaha, Nebraska;3. University of Kansas Medical Center, Kansas City, Kansas |
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Abstract: | BackgroundPreclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI).ObjectivesThis study tested the clinical effectiveness of sonothrombolysis in patients with STEMI.MethodsPatients with their first STEMI were prospectively randomized to either diagnostic ultrasound–guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared.ResultsST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 ± 22 g high MI/PCI vs. 40 ± 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 ± 11% vs. 43 ± 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF ≤30%) was reduced in the high MI/PCI group (5% vs. 18% PCI only; p = 0.045).ConclusionsSonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330). |
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Keywords: | for the acute myocardial infarction microbubbles ultrasound CMR cardiac magnetic resonance imaging CST cardiac-specific troponin DUS diagnostic ultrasound ECG electrocardiogram/electrocardiographic IS infarct size LVEF left ventricular ejection fraction MI mechanical index MVO microvascular obstruction PCI percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction TIMI Thrombolysis In Myocardial Infarction |
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