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Ma M, Wang L, Diao KY, Liang SC, Zhu Y, Wang H, Wang M, Zhang L, Yang ZG, He Y. A randomized controlled clinical trial of prolonged balloon inflation during stent deployment strategy in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a pilot study. BMC Cardiovasc Disord 2022; 22:30. [PMID: 35120436 PMCID: PMC8815170 DOI: 10.1186/s12872-022-02477-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/12/2022] [Indexed: 02/08/2023] Open
Abstract
Background Primary percutaneous coronary intervention (PPCI) is the standard procedure for reperfusion for ST-segment elevation myocardial infarction (STEMI), but the occurrence of the no-reflow phenomenon remains common and is associated with adverse outcomes. Aims This study aimed to evaluate whether prolonged balloon inflation in stent deployment would lessen the occurrence of the no-reflow phenomenon in PPCI compared with conventional rapid inflation/deflation strategy. Methods Patients were randomly assigned to either the prolonged balloon inflation in stent deployment group (PBSG) or conventional deployment strategy group (CDSG) in a 1:1 ratio. A subset of patients was included in the cardiac magnetic resonance (CMR) assessment. Results Thrombolysis in MI (TIMI) flow grade 3 was found in 96.7% and 63.3% of the patients of the PBSG and CDSG, respectively (P = 0.005). The results of the PBSG and CDSG are respectively shown as follows: 0% versus 30% no-reflow or slow flow (P = 0.002); 90% versus 66.7% ST-segment resolution ≥ 50% (P = 0.028); 35.6 ± 14.5 frames versus 49.18 ± 25.2 frames on corrected TIMI frame count (P = 0.014); and 60% versus 20% myocardial blush grade 3 (P = 0.001). At 1 month, the major cardiovascular adverse event (cardiovascular mortality) rate was 3.3% in both groups; at 1 year, the rate was 3.3% and 6.7% for the PBSG and CDSG, respectively (P = 1.00). In the CMR subset of cases, the presence of microvascular obstruction (MVO) was detected in 6.7% and 50% of the patients in the PBSG and CDSG, respectively (P = 0.023). Conclusion In our pilot trial, prolonged balloon inflation during stent deployment strategy in PPCI reduces the occurrence of the no-reflow phenomenon in patients with STEMI and improved the myocardial microcirculation perfusion (ClinicalTrials.gov number: NCT03199014; registered: 26/June/2017).
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Affiliation(s)
- Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China.,Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, China
| | - Ling Wang
- Department of Cardiology, Mian Yang People's Hospital, Chengdu, China
| | - Kai-Yue Diao
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China
| | - Shi-Chu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Hua Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Mian Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Li Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China.
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Paik GY, Kuntz RE, Baim DS. Perfusion therapy to reduce myocardial ischemia en route to emergency coronary artery bypass grafting for failed percutaneous transluminal coronary angioplasty. J Interv Cardiol 1995; 8:319-27. [PMID: 10155244 DOI: 10.1111/j.1540-8183.1995.tb00550.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Despite improvements in operator technique, catheter technology, and the development of new devices, emergency coronary artery bypass grafting (CABG) is still required in 1%-4% of attempted catheter based revascularization procedures. Patients who require such emergency CABG after failed percutaneous transluminal coronary angioplasty (PTCA) have worse acute outcomes than those undergoing elective CABG, with a higher incidence of Q wave myocardial infarction (MI) and a higher operative mortality. In patients with otherwise refractory abrupt closure, maintenance of antegrade coronary blood flow using perfusion catheters lessens the incidence of Q wave MI and lowers peak creatinine phosphokinase. Direct maintenance of coronary flow thus appears to provide more definitive control of myocardial ischemia than purely adjunctive measures, such as intra-aortic balloon pumping, cardiopulmonary support, or coronary sinus retroperfusion. Although the recent introduction of coronary stents holds great promise for definitive percutaneous reversal of abrupt closure and a dramatic decrease in the incidence of emergency CABG for failed PTCA, maintenance of antegrade flow via perfusion technology remains the cornerstone of management in reducing the perioperative mortality and morbidity of patients who still require emergency bypass surgery after failed PTCA.
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Affiliation(s)
- G Y Paik
- Charles A. Dana Research Institute, Boston, Massachusetts, USA
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