Author + information
- Received February 6, 2019
- Revision received February 25, 2019
- Accepted March 6, 2019
- Published online June 3, 2019.
- Wilson Mathias Jr., MD, PhDa,
- Jeane M. Tsutsui, MD, PhDa,
- Bruno G. Tavares, MDa,
- Agostina M. Fava, MDb,
- Miguel O.D. Aguiar, MDa,
- Bruno C. Borges, MDa,
- Mucio T. Oliveira Jr., MD, PhDa,
- Alexandre Soeiro, MD, PhDa,
- Jose C. Nicolau, MD, PhDa,
- Henrique B. Ribeiro, MD, PhDa,
- Hsu Po Chiang, MDa,
- João C.N. Sbano, MD, PhDa,
- Abdulrahman Morad, MDc,
- Andrew Goldsweig, MDb,
- Carlos E. Rochitte, MD, PhDa,
- Bernardo B.C. Lopes, MDa,
- José A.F. Ramirez, MD, PhDa,
- Roberto Kalil Filho, MD, PhDa,
- Thomas R. Porter, MDb,∗ (, )@unmc,
- for the MRUSMI Investigators
- aHeart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil
- bUniversity of Nebraska Medical Center, Omaha, Nebraska
- cUniversity of Kansas Medical Center, Kansas City, Kansas
- ↵∗Address for correspondence:
Dr. Thomas R. Porter, University of Nebraska Medical Center, Omaha, Nebraska 68198-2265.
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).
This study was supported by a research grant from the “Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).” Funding for the study coordinators was provided by the Theodore F. Hubbard Foundation from the University of Nebraska Medical Center. Dr. Nicolau has received grants/research support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Dalcor, Janssen, Novartis, Pfizer, and Vifor; and has received honoraria or consultation fees from Sanofi, Amgen, and Servier. Dr. Porter is on the Board of Directors and does lectures for meetings of the International Contrast Ultrasound Society; has received research equipment support from Philips; and has received research support from the Theodore F. Hubbard foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received February 6, 2019.
- Revision received February 25, 2019.
- Accepted March 6, 2019.
- 2019 American College of Cardiology Foundation
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