Impact of controlled stepwise reperfusion during primary percutaneous coronary intervention on patients with ST-elevation myocardial infarction

Impact of controlled stepwise reperfusion during primary percutaneous coronary intervention on patients with ST-elevation myocardial infarction AbstractObjective:The aim of this study is to examine the impact of controlled stepwise reperfusion by modulating pre-dilation balloonpressure during primary percutaneous coronary interventions (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Methods:Consecutive ST-elevation myocardial infarction patients requiring primary percutaneous coronary interventions withthrombolysis in myocardial infarction (TIMI) flow grades 0 or 1, were randomly divided into an experimental group and a control group. For the control group, the pre-dilation balloon was removed immediately after achieving antegradeperfusion beyond the lesion. The experimental group underwent stepwise reperfusion, with the balloon pressure being gradually reduced. Baseline data, intra/post-procedural primary percutaneous coronary interventions data, 3-month left ventricular ejection fraction (LVEF), and major adverse cardiac events (MACE) were documented and compared between the two groups. Results:The control group experienced more severe symptoms during the procedure (p = 0.034), higher post-procedural corrected TIMI frame counts (p = 0.047), more significant hemodynamic changes (p = 0.031), and increased rates of ventricular tachycardia/ventricular fibrillation (p = 0.035). Additionally, they had a higher total number of arrhythmias (p = 0.017), a lower 90-min ST segment resolution rate (p = 0.045), and elevated cTNI levels one week after the procedure (p = 0.047). Three months later, the control group demonstrated a lower LVEF compared to the experimental group (p = 0.048) and a trend towards more drug-treated arrhythmias (p = 0.073). No differences were observedin other statistical results.Conclusion:In patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary interventions, controlled stepwise reperfusion by adjusting the pre-dilation balloon pressure effectively reduces myocardial ischemia-reperfusion injury, improves myocardial perfusion,and supports the recovery of cardiac function.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.