Impact of intracoronary reteplase during primary percutaneous coronary intervention on infarct size in large anterior myocardial infarction: rationale and design of the RECOVER II trial

Abstract

Background: Thrombus embolization and microvascular obstruction during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is commonly detected, which causes inadequate myocardial perfusion and elevated infarct size. An approach with low-dose intracoronary fibrinolytic treatment for reducing distal embolization and improving myocardial reperfusion in high-risk STEMI cases remains controversial. Methods:The RECOVER II study represents a multicenter, randomized, double-blind, parallel-group trial assessing low-dose adjunctive intracoronary reteplase during primary PCI in individuals with large anterior myocardial infarction and thrombus determined by angiography. The trial will enroll 306 cases who present within 12 h following STEMI for proximal or mid left anterior descending artery occlusion undergoing primary PCI. Cases will be randomized to receive a bolus intracoronary reteplase at 9 mg or 18 mg vs. placebo. The drug will be delivered over 2 minutes proximal to culprit lesions with an intracoronary catheter early after wire-crossing and before thrombus aspiration or balloon dilation. Results:The primary outcome will be infarct size assessed by late gadolinium-enhanced magnetic resonance imaging (MRI) (% of left ventricular mass) on day 7 after enrollment. Secondary outcomes will include the amount of microvascular obstruction and myocardial salvage index examined via MRI on day 7, angiographic measures of reperfusion [Thrombolysis in Myocardial Infarction (TIMI) coronary flow grade, TIMI frames count and myocardial blush grade], incidence of complete ST-segment resolution at 2 hours after reperfusion, area under the curve for troponin T, and rates of major adverse cardiovascular events at 30 days.Conclusions: RECOVER II will determine whether the addition of low-dose intracoronary reteplase early after wire-crossing as an adjunct to reperfusion treatment reduces infarct size in individuals with large anterior myocardial infarction.

Thrombus Aspiration in Acute Myocardial Infarction: A Long-Awaited Resurgence?

“…Newer studies offer hope for a possible resurgence of thromboaspiration with the availability of better tools, and most importantly optimized adjuvant intracoronary and/or intravenous antithrombotic, antiplatelet, vasodilatory and myocardium-preserving therapies. 6,[11][12][13][14][15] For now, it seems that patients with a high coronary thrombus burden may be those most likely to benefit from selective thromboaspiration, always aided by adjuvant pharmacotherapies. 6,11,16 ORCID iD Antonis S. Manolis  https://orcid.org/0000-0002-0336-4745…”

The Recovery of Left Ventricular Function in Cases of Primary Angioplasty for Acute Myocardial Infarction

“…1,2 Prolonged blockage of arteries leads to a lack of oxygen to the heart muscle, which may result to the death of a particular part of the heart. 3 Left ventricular function (LVF) is the main predictor of long-term prognosis in cases of survival after acute myocardial infarction 4 .But, LVF may change after few months of MI due to gradual relief of stunning and remodelling mechanisms. Through the determinants of improvement in LVF it becomes easier Conflict of interest: The authors declared no conflict of interest exists.…”