1. Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
- Author
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Alexandre de Matos Soeiro, Agostina M Fava, Andrew M. Goldsweig, Jeane M. Tsutsui, Bruno C. Borges, Bruno G. Tavares, Henrique Barbosa Ribeiro, Hsu Po Chiang, Ramirez Ja, Mucio Tavares de Oliveira, Roberto Kalil Filho, Thomas R. Porter, Bernardo B.C. Lopes, Abdulrahman Morad, João C.N. Sbano, Jose C. Nicolau, Wilson Mathias, Mrusmi Investigators, Carlos E. Rochitte, and Miguel Osman Aguiar
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,Coronary artery disease ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,ST segment ,Humans ,Single-Blind Method ,Thrombolytic Therapy ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Ultrasonography, Interventional ,Aged ,Fluorocarbons ,Ejection fraction ,Microbubbles ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Magnetic Resonance Imaging ,surgical procedures, operative ,Treatment Outcome ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mechanical index - Abstract
Preclinical 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).This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI.Patients 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.ST-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).Sonothrombolysis 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).
- Published
- 2019