دورية أكاديمية
أعرض في EDS

Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.

التفاصيل البيبلوغرافية
العنوان: Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.
المؤلفون: Mathias W Jr; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Tsutsui JM; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Tavares BG; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Fava AM; University of Nebraska Medical Center, Omaha, Nebraska., Aguiar MOD; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Borges BC; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Oliveira MT Jr; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Soeiro A; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Nicolau JC; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Ribeiro HB; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Chiang HP; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Sbano JCN; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Morad A; University of Kansas Medical Center, Kansas City, Kansas., Goldsweig A; University of Nebraska Medical Center, Omaha, Nebraska., Rochitte CE; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Lopes BBC; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Ramirez JAF; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Kalil Filho R; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Porter TR; University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: trporter@unmc.edu.
مؤلفون مشاركون: MRUSMI Investigators
المصدر: Journal of the American College of Cardiology [J Am Coll Cardiol] 2019 Jun 11; Vol. 73 (22), pp. 2832-2842. Date of Electronic Publication: 2019 Mar 17.
نوع المنشور: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1558-3597 (Electronic) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
مواضيع طبية MeSH: Percutaneous Coronary Intervention/*methods , ST Elevation Myocardial Infarction/*therapy , Thrombolytic Therapy/*methods , Ultrasonography, Interventional/*methods, Aged ; Combined Modality Therapy ; Coronary Angiography ; Electrocardiography ; Female ; Fluorocarbons/administration & dosage ; Humans ; Magnetic Resonance Imaging ; Male ; Microbubbles ; Middle Aged ; Prospective Studies ; ST Elevation Myocardial Infarction/diagnostic imaging ; Single-Blind Method ; Treatment Outcome
مستخلص: Background: 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).
Objectives: This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI.
Methods: 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.
Results: 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).
Conclusions: 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).
(Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: J Am Coll Cardiol. 2019 Jun 11;73(22):2843-2845. (PMID: 31171089)
فهرسة مساهمة: Keywords: acute myocardial infarction; microbubbles; ultrasound
سلسلة جزيئية: ClinicalTrials.gov NCT02410330
المشرفين على المادة: 0 (Fluorocarbons)
CK0N3WH0SR (perflutren)
تواريخ الأحداث: Date Created: 20190322 Date Completed: 20200327 Latest Revision: 20221207
رمز التحديث: 20240628
DOI: 10.1016/j.jacc.2019.03.006
PMID: 30894317
قاعدة البيانات: MEDLINE
الوصف
تدمد:1558-3597
DOI:10.1016/j.jacc.2019.03.006