Pressure‐controlled intermittent coronary sinus occlusion improves the vasodilatory microvascular capacity and reduces myocardial injury in patients with <scp>STEMI</scp>

Scarsini, Roberto; Terentes‐Printzios, Dimitrios; Shanmuganathan, Mayooran; Kotronias, Rafail A.; Borlotti, Alessandra; Marin, Federico; Langrish, Jeremy P.; Lucking, Andrew J.; Ribichini, Flavio; Kharbanda, Rajesh K.; Ferreira, Vanessa M.; Channon, K M; Maria, Giovanni Luigi De; Banning, Adrian

doi:10.1002/ccd.29793

Cited by 21 publications

(16 citation statements)

References 21 publications

(66 reference statements)

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“…If the femoral artery route were established, IABP can be prepared simultaneously. Recently, STEMI DTU 30 was treated with left ventricular unloading 30 minutes before reperfusion, a significant improvement in the ratio of AAR to IS was observed; PiCSO therapy 31 may improve microvascular function and vasodilatory capacity, which contributes to reducing IS in patients with STEMI undergoing PPCI. PiCSO need 15-30 minutes for sheath preparation and cannulating the coronary sinus before coronary reperfusion.…”

Section: Discussionmentioning

confidence: 99%

A novel reperfusion method in patients with acute ST elevation myocardial infarction during primary percutaneous coronary intervention: A randomized control trial

He,

Yang,

Liu

et al. 2023

Preprint

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BACKGROUNDReperfusion injury is associated with larger infarct size and drawback of long-term outcome in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Volume-Controlled Reperfusion (VCR) is our original reperfusion method combined with accurate gentle reperfusion and active protection for unstable plaque. A single center, prospective, randomized clinical trial was conducted to demonstrate the feasibility, clinical safety, and potential effects of VCR in STEMI patients during PPCI.METHODS AND RESULTSA total of 60 patients with STEMI presenting within 12 h of symptom onset undergoing PPCI were randomized enrolled to VCR group (n=30) or control group (n=30). Patients in VCR group recanalized with VCR followed by routine PCI. Patients in control group recanalized with routine PCI procedure only. The primary endpoint was all-cause death and major adverse cardiac events (MACE) during hospitalization and followed up, the main second endpoints were MVO extent measured 5-7 days post PPCI and left ventricular function. Baseline characteristics were well matched between two groups. No MACE from in-hospital to 1 year followed up in VCR group. In-hospital echocardiography based left ventricular eject fraction (LVEF) in VCR group compared with control group was (57.6 ± 6.2) % vs (52.9 ± 8.5) %, p = 0.018; especially in anterior STEMI VCR subgroup (55.1 ± 6.3) % v (s 48.6 ± 6.4) %, p = 0.003. There was no significant difference in infarct size, MVO mass or MVO mass/infarct mass ratio by late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-CMR). In hospital CMR based LVEF in anterior STEMI VCR subgroup was (50.55 ± 7.55) % vs (40.53 ± 7.39) %, p = 0.002. Follow up echocardiography based LVEF were (64.12 ± 6.35) % vs (59.44 ± 8.20) %, p = 0.025 between two groups and (62.07 ± 7.06) % vs (55.94 ± 6.70) %, p = 0.016 between anterior STEMI subgroups.CONCLUSIONSThis is the pilot RCT study demonstrated that VCR method was feasibility and clinical safe among patients with acute STEMI during PPCI to 12-month follow-up, indicated potential attenuate effect in reperfusion injury as well. Staged II RCT is needed to verify clinical benefit.REGISTRATIONURL:http://www.chictr.org.cn. Unique identifier: ChiCTR00052856

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Section: Discussionmentioning

confidence: 99%

A novel reperfusion method in patients with acute ST elevation myocardial infarction during primary percutaneous coronary intervention: A randomized control trial

He,

Yang,

Liu

et al. 2023

Preprint

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“…Coronary microvascular dysfunction in the STEACS setting is prognostically important (4,5,18), and its early and reliable identification during pPCI can guide stratification of adjunct therapies (24)(25)(26). Early work has shown that macroscopically red thrombi are associated with an adverse prognostic outcome (8, 9).…”

Section: Discussionmentioning

confidence: 99%

Machine learning assisted reflectance spectral characterisation of coronary thrombi correlates with microvascular injury in patients with ST-segment elevation acute coronary syndrome

Kotronias

Fielding

Greenhalgh

et al. 2022

Front. Cardiovasc. Med.

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AimsWe set out to further develop reflectance spectroscopy for the characterisation and quantification of coronary thrombi. Additionally, we explore the potential of our approach for use as a risk stratification tool by exploring the relation of reflectance spectra to indices of coronary microvascular injury.Methods and resultsWe performed hyperspectral imaging of coronary thrombi aspirated from 306 patients presenting with ST-segment elevation acute coronary syndrome (STEACS). Spatially resolved reflected light spectra were analysed using unsupervised machine learning approaches. Invasive [index of coronary microvascular resistance (IMR)] and non-invasive [microvascular obstruction (MVO) at cardiac magnetic resonance imaging] indices of coronary microvascular injury were measured in a sub-cohort of 36 patients. The derived spectral signatures of coronary thrombi were correlated with both invasive and non-invasive indices of coronary microvascular injury. Successful machine-learning-based classification of the various thrombus image components, including differentiation between blood and thrombus, was achieved when classifying the pixel spectra into 11 groups. Fitting of the spectra to basis spectra recorded for separated blood components confirmed excellent correlation with visually inspected thrombi. In the 36 patients who underwent successful thrombectomy, spectral signatures were found to correlate well with the index of microcirculatory resistance and microvascular obstruction; R2: 0.80, p < 0.0001, n = 21 and R2: 0.64, p = 0.02, n = 17, respectively.ConclusionMachine learning assisted reflectance spectral analysis can provide a measure of thrombus composition and evaluate coronary microvascular injury in patients with STEACS. Future work will further validate its deployment as a point-of-care diagnostic and risk stratification tool for STEACS care.

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“…Egred et al (2020) obtained the important conclusion that patients who received PiCSO after reperfusion have a significantly smaller infarct size at 5 days and no procedural or device-related adverse effects [ 59 ]. A year later, Scarsini et al (2021) reached four key results in the PiCSO study: PiCSO immediately improved microvascular function after PCI in STEMI patients; PiCSO positively influenced coronary microcirculatory vasodilation; PiCSO-assisted PCI demonstrated a smaller infarct size at 6 months; PiCSO showed promising results in treating inferior STEMI [ 102 ]. …”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

“…The effects of PiCSO in the heart reach a molecular level, by increasing relevant microRNA and transcription factors favoring cardiac regeneration by acting on cardiomyocytes and cardiac fibroblasts [ 60 ]. Further investigations are being conducted on PiCSO, yet there is still a lot to learn from this therapy; therefore, further investigation on this topic will be very beneficial ( Table 1 ) [ 58 , 59 , 60 , 102 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

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In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.

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Pressure‐controlled intermittent coronary sinus occlusion improves the vasodilatory microvascular capacity and reduces myocardial injury in patients with STEMI

Cited by 21 publications

References 21 publications

A novel reperfusion method in patients with acute ST elevation myocardial infarction during primary percutaneous coronary intervention: A randomized control trial

A novel reperfusion method in patients with acute ST elevation myocardial infarction during primary percutaneous coronary intervention: A randomized control trial

Machine learning assisted reflectance spectral characterisation of coronary thrombi correlates with microvascular injury in patients with ST-segment elevation acute coronary syndrome

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

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