دورية أكاديمية
Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.
العنوان: | Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. |
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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 |
تدمد: | 1558-3597 |
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DOI: | 10.1016/j.jacc.2019.03.006 |