Key result
Pressure-controlled intermittent coronary sinus occlusion as an adjunct to thrombolysis significantly reduced the risk of major adverse cardiovascular events compared to thrombolysis alone (RR 0.12).
Why the study?
Does pressure-controlled intermittent coronary sinus occlusion (PICSO) as an adjunct to primary thrombolysis reduce long-term major adverse cardiovascular events in patients with ST-elevated myocardial infarction?
RCT (n=34)
Randomized
No
Does pressure-controlled intermittent coronary sinus occlusion (PICSO) as an adjunct to primary thrombolysis reduce long-term major adverse cardiovascular events in patients with ST-elevated myocardial infarction?
Effect estimate: RR 0.12 (95% CI 0.03-0.42)
Absolute Event Rate: 17.6% vs 70.6%
p-value: p=<0.0001
In a long-term follow-up of patients with anterior STEMI, the addition of PICSO to primary thrombolysis significantly reduced the risk of major adverse cardiovascular events and reinfarction compared to thrombolysis alone.
Supports PICSO adjunct to thrombolysis in anterior STEMI; extends RCT evidence for sustained MACE reduction.
BACKGROUND: Recent reports on facilitated reperfusion therapy re-address interests in coronary sinus interventions (CSI). Patients in whom short time results have been reported earlier were re-evaluated, with the aim of gathering the long-term results of pressure-controlled intermittent coronary sinus occlusion (PICSO) generated in patients with acute myocardial infarction (MI) and revascularization. METHODS AND RESULTS: Thirty-four patients with ST elevated MI, in whom complete revascularization was achieved, underwent primary thrombolysis with or without PICSO. Follow-up data from these patients were collected for at least 48 months. Immediate perioperative differences were observed for time to peak creatine kinase (CK), as well as cumulative CK. In addition, the time until reperfusion was considerably less than for the control group (p=0.014). Long-term data showed significant differences in reinfarction (p=0.015), as well as in major adverse cardiovascular events, between the 2 groups (p<0.0001). CONCLUSION: These data, because of the wide interval between collection and current analysis, could have inherited historical bias. Nonetheless, they are also uniquely indicating the potential of CSI to induce not only immediate, but also clinically significant long-term, effects as an adjunct to reperfusion therapy. Therefore, CSI should be, once again, on the study agenda and be placed under contemporary and best-available scientific scrutiny.
No takes yet. Share an insight, caveat, or question.
Möhl et al. (2007) conducted an RCT in Acute Myocardial Infarction (n=34). Pressure-controlled intermittent coronary sinus occlusion (PICSO) vs. Thrombolysis alone was evaluated on Time to first occurrence of major adverse cardiovascular events (MACE) (RR 0.12, 95% CI 0.03-0.42, p=<0.0001). Pressure-controlled intermittent coronary sinus occlusion as an adjunct to thrombolysis significantly reduced the risk of major adverse cardiovascular events compared to thrombolysis alone (RR 0.12).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: