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

MRUSMI Investigators

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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).

Original languageEnglish (US)
Pages (from-to)2832-2842
Number of pages11
JournalJournal of the American College of Cardiology
Volume73
Issue number22
DOIs
StatePublished - Jun 11 2019

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Percutaneous Coronary Intervention
ST Elevation Myocardial Infarction
Microbubbles
Implantable Defibrillators
Therapeutic Uses
Diagnostic Imaging
Random Allocation
Transducers
Intravenous Infusions
Coronary Artery Disease
Ultrasonography

Keywords

  • acute myocardial infarction
  • microbubbles
  • ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: Journal of the American College of Cardiology, Vol. 73, No. 22, 11.06.2019, p. 2832-2842.

Research output: Contribution to journalArticle

@article{d7fa298da7ce421e8216d36c136505e6,
title = "Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention",
abstract = "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).",
keywords = "acute myocardial infarction, microbubbles, ultrasound",
author = "{MRUSMI Investigators} and Wilson Mathias and Tsutsui, {Jeane M.} and Tavares, {Bruno G.} and Fava, {Agostina M.} and Aguiar, {Miguel O.D.} and Borges, {Bruno C.} and Oliveira, {Mucio T.} and Alexandre Soeiro and Nicolau, {Jose C.} and Ribeiro, {Henrique B.} and Chiang, {Hsu Po} and Sbano, {Jo{\~a}o C.N.} and Abdulrahman Morad and Andrew Goldsweig and Rochitte, {Carlos E.} and Lopes, {Bernardo B.C.} and Ramirez, {Jos{\'e} A.F.} and {Kalil Filho}, Roberto and Porter, {Thomas R.}",
year = "2019",
month = "6",
day = "11",
doi = "10.1016/j.jacc.2019.03.006",
language = "English (US)",
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pages = "2832--2842",
journal = "Journal of the American College of Cardiology",
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TY - JOUR

T1 - Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

AU - MRUSMI Investigators

AU - Mathias, Wilson

AU - Tsutsui, Jeane M.

AU - Tavares, Bruno G.

AU - Fava, Agostina M.

AU - Aguiar, Miguel O.D.

AU - Borges, Bruno C.

AU - Oliveira, Mucio T.

AU - Soeiro, Alexandre

AU - Nicolau, Jose C.

AU - Ribeiro, Henrique B.

AU - Chiang, Hsu Po

AU - Sbano, João C.N.

AU - Morad, Abdulrahman

AU - Goldsweig, Andrew

AU - Rochitte, Carlos E.

AU - Lopes, Bernardo B.C.

AU - Ramirez, José A.F.

AU - Kalil Filho, Roberto

AU - Porter, Thomas R.

PY - 2019/6/11

Y1 - 2019/6/11

N2 - 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).

AB - 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).

KW - acute myocardial infarction

KW - microbubbles

KW - ultrasound

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