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Sonothrombolysis beneficial in STEMI

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NEW ORLEANS — Among patients with STEMI, adding sonothrombolysis to PCI improved recanalization rates and reduced infarct size, according to findings from the MRUSMI trial presented at the American College of Cardiology Scientific Session.

The researchers investigated whether applying high mechanical index impulses from a diagnostic ultrasound transducer during a microbubble infusion would improve patency rates, reduce infarct size, improve myocardial flow and improve long-term left ventricular systolic function in patients with their first STEMI, Wilson Mathias Jr., MD, PhD, from the Heart Institute (InCor), University of São Paulo Medical School, said during a presentation.

The researchers randomly assigned 100 patients to sonothrombolysis with PCI (mean age, 59 years; 64% men) or PCI alone (mean age, 59 years; 80% men). They also analyzed 203 patients who arrived at the hospital with STEMI outside the randomization window (reference group; mean age, 59 years; 73% men). The findings were simultaneously published in the Journal of the American College of Cardiology.

Before PCI, ST-segment resolution had already occurred in 32% of the sonothrombolysis group compared with only 4% of the PCI-only group, according to the researchers.

Furthermore, angiographic recanalization occurred in 48% of the sonothrombolysis group compared with 20% of the PCI-only and reference groups before PCI (P < .001), Mathias and colleagues found.

Infarct size, assessed by MRI at 48 to 72 hours after infarction, was less in the sonothrombolysis group compared with the PCI-only group (29 g vs. 40 g; P = .026).

Before treatment, LV ejection fraction was similar in the sonothrombolysis and PCI-only groups (44% vs. 43%, respectively), but immediately after treatment, it was higher in the sonothrombolysis group (P = .03) and the difference persisted at 6 months (P = .015), according to the researchers.

Among patients with STEMI, adding sonothrombolysis to PCI improved recanalization rates and reduced infarct size, according to findings from the MRUSMI trial presented at the American College of Cardiology Scientific Session.

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Need for an implantable defibrillator, defined as LVEF 30% or less, occurred in only 5% of the sonothrombolysis group compared with 18% of the PCI-only group (P = .045), Mathias said.

“Transthoracic sonothrombolysis improved infarct vessel patency and reduced ST-segment elevation in STEMI patients pre-PCI,” he said. “This improves macrovascular flow, reduces infarct size and, consequently, restores left ventricular function.” – by Erik Swain

References:

Mathias W Jr, et al. Featured Clinical Research II: Interventional. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.

Mathias W Jr, et al. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.03.006.

Disclosure: Mathias reports no relevant financial disclosures.