Author + information
- Mohaned Egred1,
- Roger Kessels2,
- Alan Bagnall1,
- Ioakim Spyridopoulos3,
- Nick Palmer4,
- Ever Grech5,
- Ajay Jain6,
- Gregg Stone7,
- Robin Nijveldt8 and
- Thomas McAndrew9
- 1Freeman Hospital, Newcastle upon Tyne, United Kingdom
- 2Miracor Medical Systems GmbH, Vienna, Austria
- 3Newcastle University, Newcastle upon Tyne, United Kingdom
- 4The Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- 5Northern General Hospital, Sheffield, United Kingdom
- 6Barts Heart Centre, London, United Kingdom
- 7Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 8Radboudumc, Nijmegen, Netherlands
- 9Cardiovascular Research Foundation, New York, New York, United States
The use of pressure-controlled intermittent coronary sinus occlusion (PiCSO) has been shown to decrease ischemic damage during coronary occlusions in pre-clinical studies. Whether PiCSO reduces infarct size in patients with STEMI undergoing primary PCI is unknown.
In the parallel-arm non-randomized UK PiCSO in adjunct to PCI study, patients with a first anterior infarct underwent PiCSO treatment after TIMI 3 flow was established in the infarct related artery. Infarct size was assessed by cardiac MRI on day 5, and was compared to control patients without PiCSO from the INFUSE-AMI with day 5 cardiac MRI. A statistician, blinded to infarct size, balanced the PiCSO and INFUSE-AMI cohorts on sex, age, pre-PCI TIMI flow (0/1 vs 2/3), post-PCI TIMI flow (2 vs 3), diabetes mellitus, culprit lesion location (proximal vs mid LAD), and symptom to balloon time with a propensity score adjusted ∼1:3 match. A second statistician compared the infarct size between PiCSO and INFUSE-AMI patients.
Twenty patients enrolled in the PiCSO study and 80 control patients from INFUSE-AMI were available. After propensity score matching, 15 PiCSO patients and 40 INFUSE-AMI remained. Baseline variables were well matched between the groups. Mean infarct size (% total left ventricular mass) in PiCSO treated patients was 10.9% (95% CI 5.1%, 16.8%), which was less than that in the INFUSE-AMI control group (20.9% (95% CI 17.33%, 24.48%)); mean difference -10.0% (95% CI -16.8%, -3.2%), p-value = 0.004.
In the present propensity matched analysis, initiation of PiCSO in patients with acute anterior MI immediately after flow restoration but before stenting was associated with a 47% relative reduction in 5-day infarct size. These findings have formed the basis for an upcoming randomized trial to determine the safety and efficacy of PiCSO in patients with anterior STEMI undergoing primary PCI.
CORONARY: Acute Myocardial Infarction