An observational study in Acute Myocardial Infarction, sponsored by Sejong General Hospital. Status unknown at 1 site in Korea, Republic of. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2017-08-08.
Sponsored by Sejong General Hospital · Observational
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.
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.
Patients undergoing primary precutaneous coronary intervention for ST- segment elevation or Non ST-segment elevation myocardial infarcation with ongoing myocardial ischemia
Exclusion Criteria:
Conventional stenting immediate after the re-opening of infarct-related artery during primary PCI
Elective stenting following cooling down of infarct- related artery for several days after restoration of epicardial coronary blood flow during primary PCI
Procedure: Deferred stenting
Previously described
Index of microcirculatory resistance of infarct-related artery
Measured by pressure and temperature sensors- tipped guide wire
Time frame: 3 to 5 days after primary reperfusion (TIMI 3 flow achievement) in both groups
The rate of urgent revascularization
Time frame: During index hospitalization (intraoperative)
Major bleeding
Defined as TIMI bleeding criteria
Time frame: During index hospitalization (intraoperative)
Major adverse cardiac events
Death, myocardial infarction, unplanned target vessel revascularization or CHF admission
Time frame: One- year after primary reperfusion
Plan to share: No
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Sejong General Hospital