Sonothrombolysis in ST-segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

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Publication date: Available online 17 March 2019

Source: Journal of the American College of Cardiology

Author(s): Wilson Mathias, Jeane M. Tsutsui, Bruno G. Tavares, Agostina M. Fava, Miguel O.D. Aguiar, Bruno C. Borges, Mucio T. Oliveira, Alexandre Soeiro, Jose C. Nicolau, Henrique B. Ribeiro, Hsu Pochiang, João C.N. Sbano, Abdulrahman Morad, Andrew Goldsweig, Carlos E. Rochitte, Bernardo B.C. Lopes, José A.F. Ramirez, Roberto Kalil Filho, Thomas R. Porter, The Microvascular Recovery with Ultrasound in Acute Myocardial Infarction (MRUSMI) Investigators

Abstract

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.