Key result
Intracoronary delivery of cardioprotective agents during primary PCI for acute myocardial infarction yielded similar rates of successful procedures compared to standard PCI (93.8% vs 97.4%, p=0.374).
Why the study?
The safety of local intracoronary injection of cardioprotective agents prior to re-establishment of TIMI III flow during primary PCI for acute myocardial infarction was uncertain.
Does the delivery of an intracoronary agent prior to balloon dilatation during primary percutaneous coronary intervention affect safety or microvascular damage in patients with acute myocardial infarction?
Does the delivery of an intracoronary agent prior to balloon dilatation during primary percutaneous coronary intervention affect safety or microvascular damage in patients with acute myocardial infarction?
Absolute Event Rate: 93.8% vs 97.4%
p-value: p=0.374
Intracoronary infusion of cardioprotective agents prior to restoring TIMI flow during primary PCI for acute myocardial infarction is safe and does not increase microvascular damage.
Similar procedural success supports feasibility of intracoronary delivery in primary PCI; leaves open efficacy for cardioprotection.
Background The local injection of novel cardioprotective study drugs prior to percutaneous coronary intervention could cause embolisation of thrombus, resulting in increased reperfusion injury and subsequent infarct size. The aim of this study was to assess the safety of the delivery of an intracoronary therapy delivered during primary percutaneous coronary intervention for acute myocardial infarction prior to the re-establishment of thrombolysis in myocardial infarction III flow. Methods One hundred sixty-seven patients with acute myocardial infarction successfully reperfused through primary percutaneous coronary intervention and undergoing Cardiac MRI within the first week after reperfusion were studied. Patients either underwent the delivery of an intracoronary agent (IMP or placebo) prior to balloon dilatation ( n = 80) or standard primary percutaneous coronary intervention procedure ( n = 117). Results Baseline characteristics were similar between the two groups. There were a similar number of successful procedures (IC IMP 75 (93.8%) vs. No IMP 114, (97.4%), p = 0.374), rates of no-reflow (IC IMP 1 (1.3%) vs. No IMP 2 (1.7%), p = 0.99) and levels of ST segment resolution (88.5% IC IMP vs. No IC IMP 87.0%, p = 0.669) between the two groups. Similar levels of microvascular obstruction were seen between the two groups with a trend to reduced infarct size, and improved ejection fractions in the IMP group. Lower MACE rates were seen in the IMP group. Conclusion The local intracoronary infusion of potential cardioprotective agents prior to the restoration of TIMI flow in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction appears to be safe and does not increase microvascular damage. This route should be considered when testing novel cardioprotective agents.
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Rathod et al. (2017) studied Acute myocardial infarction (n=167). Intracoronary delivery of a cardioprotective agent vs. Standard primary percutaneous coronary intervention was evaluated on Successful procedures (p=0.374). Intracoronary delivery of cardioprotective agents during primary PCI for acute myocardial infarction yielded similar rates of successful procedures compared to standard PCI (93.8% vs 97.4%, p=0.374).
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