Acute Myocardial Infarction
Conditions
Keywords
Deferred stenting, Microvascular dysfunction
Brief summary
This study will compare the microcirculatory resistance (IMR) of infarct-related artery (IRA) in patients who underwent immediate versus deferred stenting during percutaneous coronary intervention (PCI) for acute myocardial infarction.
Detailed description
Primary PCI with immediate stenting (IS) is the current standard of reperfusion strategy for STEMI. However, it is thought that IS may cause additional myocardial injury by increasing distal embolization of clot and atheromatous plaque debris. Only about 35% of patients without cardiogenic shock can achieve optimal myocardial tissue perfusion at the microvascular level, even after restoration of epicardial coronary artery patency. IS in highly pro-thrombotic and inflammatory milieu of IRA during primary PCI would increase distal embolization of clot and atheromatous plaque debris, and provoke the inflammation process, so deferred stenting after a cooling down period of IRA for several days, have a potential to mitigate or prevent microvascular obstruction (MVO). Among several methods to evaluate MVO after STEMI, IMR has been well known as an good indicator of MVO and strong predictor for short and long term clinical outcomes.
Interventions
PROCEDUREDeferred stenting
Previously described
Sponsors
Sejong General Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. More than 30 minutes in duration of typical chest pain 2. Thrombolysis In Myocardial Infarction (TIMI) flow 0, 1 or 2 prior to the procedure
Exclusion criteria
1. Cardiogenic shock, 2. Previous history of myocardial infarction, or coronary artery bypass surgery 3. Rescue PCI after fibrinolysis 4. Life expectancy of less than 1 year 5. Acute occlusion of left main coronary artery 6. STEMI due to stent thrombosis 7. Major coronary dissection (type D\ F) following procedures achieving TIMI 3 flow
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Index of microcirculatory resistance of infarct-related artery | 3 to 5 days after primary reperfusion (TIMI 3 flow achievement) in both groups | Measured by pressure and temperature sensors- tipped guide wire |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The rate of urgent revascularization | During index hospitalization (intraoperative) | — |
| Major bleeding | During index hospitalization (intraoperative) | Defined as TIMI bleeding criteria |
| Major adverse cardiac events | One- year after primary reperfusion | Death, myocardial infarction, unplanned target vessel revascularization or CHF admission |
Countries
South Korea
Contacts
Primary ContactHyun Jong Lee, MD
Outcome results
None listed