Author + information
- Received February 6, 2019
- Revision received February 25, 2019
- Accepted March 6, 2019
- Published online March 17, 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 Pochiang, 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,
- The Microvascular Recovery with Ultrasound in Acute Myocardial Infarction (MRUSMI) Investigators
- aHeart Institute (InCor)- University of São Paulo, Medical School, São Paulo, Brazil
- bUniversity of Nebraska Medical Center, Omaha, NE
- cUniversity of Kansas Medical Center, Kansas City, KS
- ↵∗Address for Correspondence: Thomas R. Porter MD University of Nebraska Medical Center 982265 Nebraska Medical Center Omaha, NE 68198-2265 Telephone: 402.559.8150 Fax: 402.559.8355.
Background Pre-clinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer (DUS) during an intravenous microbubble infusion (Sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI).
Objective We tested the clinical effectiveness of sonothrombolysis in patients with STEMI.
Methods Patients with their first STEMI were prospectively randomized to either DUS-guided high MI impulses during an intravenous ultrasound agent infusion prior to, 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 prior to PCI, ST-segment resolution, infarct size (IS) by magnetic resonance imaging, and systolic function (LVEF) at six months were compared.
Results ST-segment resolution occurred in 16 (32%) high MI PCI versus 2(4%) PCI only patients prior to PCI, and angiographic recanalization was 48% in high/MI PCI versus 20% in PCI only and reference groups (p<0.001). IS was reduced (29+22 grams high MI/PCI versus 40+20 grams PCI only; p=0.026). LVEF was not different between groups before treatment (44+11% versus 43+10%), but increased immediately after PCI in the high MI/PCI group (p=0.03), and remained higher at six months (p=0.015). Need for implantable defibrillator (LVEF<30%) was reduced in the high MI/PCI group (5% versus 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.
- Received February 6, 2019.
- Revision received February 25, 2019.
- Accepted March 6, 2019.
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