Sonothrombolysis after percutaneous coronary intervention in STEMI patients with increased risk for microvascular obstruction: a multicenter randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Private company. Main source(s): Lantheus. Introduction Despite successful recanalization with percutaneous coronary intervention (PCI), approximately 50% patients ST-elevation myocardial infarction (STEMI) suffer from ongoing due to microvascular obstruction (MVO) (1). The use intravascular microbubbles concomittant intermittent high mechanical index (HMI) ultrasound impulses has been shown dissolve thrombi and augment perfusion through vasodilative pathways (2). This technique, also termed sonothrombolysis, could be used in STEMI at risk developing MVO, enhance reperfusion limit infarct size. Methods In this multi-center, prospective, randomized controlled trial, 118 increased for MVO (defined as occlusion the LAD artery [center 1] or incomplete ST-resolution (≤70%) on ECG after PCI irrespective culprit 2]) will sonothrombolysis control. Sonothrombolysis treatment consists a 3% infusion lipid-coated microspheres 40–80 transthoracic HMI flashes. Control cases receive low no more than 6 flashes imaging. Primary endpoints are size (% LV mass) left ventricular ejection fraction (LVEF %) assessed cardiac magnetic resonance (CMR) imaging two months inclusion. Secondary include changes LVEF CMR (CMR < 1 week vs 2 months), ST-resolution, clinical outcome six Results To date, 100 have included. Mean age was 62 (± 12) 82 (82%) were male. Culprit included center 38 (72%),RCA 11 (21%) LCX 4 (7%). Time first medical contact 97 (IQR: 48–174) 105 55–228) minutes time diagnosis 45 36–63) 49 40–59) group control respectively. Summed before (before randomization) not statistically different: 11.5 mm (6.5 – 16.1) 11.2 (5.9–16.9) (p = 0.81) 8.4 (4.3 13.0) 9.7 (4.1–16.4) 0.39) PCI, group. No differences between groups observed history drug admission. Conclusions worse prognosis (3). trial aims assess efficacy post-PCI patient population final salvage function. Currently, overall similar baseline characteristics. Inclusion, blinded assessment primary secondary follow up is expected completed 2023.