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. 2020 May 15:28:100526.
doi: 10.1016/j.ijcha.2020.100526. eCollection 2020 Jun.

Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study

Mohaned Egred  1 , Alan Bagnall  1 , Ioakim Spyridopoulos  1 , Ian F Purcell  1 , Rajiv Das  1 , Nick Palmer  2 , Ever D Grech  3 , Ajay Jain  4 , Gregg W Stone  5 , Robin Nijveldt  6 , Thomas McAndrew  5 , Azfar Zaman  1
Affiliations

Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study

Mohaned Egred et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The aim of this clinical research was to investigate the effects of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size at 5 days after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods and results: This comparative study was carried out in four UK hospitals. Forty-five patients with anterior STEMI presenting within 12 h of symptom onset received pPCI plus PiCSO (initiated after reperfusion; n = 45) and were compared with a propensity score-matched control cohort from INFUSE-AMI (n = 80). Infarct size (% of LV mass, median [interquartile range]) measured by cardiac magnetic resonance (CMR) at day 5 was significantly lower in the PiCSO group (14.3% [95% CI 9.2-19.4%] vs. 21.2% [95% CI 18.0-24.4%]; p = 0.023). There were no major adverse cardiac events (MACE) related to the PiCSO intervention.

Conclusions: PiCSO, as an adjunct to pPCI, was associated with a lower infarct size at 5 days after anterior STEMI in a propensity score-matched population.

Keywords: ACS, acute coronary syndrome; AMI, acute myocardial infarction; BARC, Bleeding Academic Research Consortium; CI, Confidence interval; CMR, Cardiac magnetic resonance; CRT, Cardiac Resynchronization Therapy; IMR, Index of microcirculatory resistance; Infarct size reduction; LAD, left anterior descending artery; LV, Left ventricle; MACE, Major adverse cardiac events; PiCSO, Pressure-controlled intermittent coronary sinus occlusion; Pressure-controlled intermittent coronary sinus occlusion (PICSO); SD, Standard deviation; ST-segment elevation myocardial infarction (STEMI); STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombosis in myocardial infarction; pPCI, Primary percutaneous coronary intervention.

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Conflict of interest statement

The authors declare the following conflicts of interests:•Mohaned Egred reports no relationships that could be construed as a conflict of interest•Alan Bagnall reports no relationships that could be construed as a conflict of interest•Ioakim Spyridopoulos reports no relationships that could be construed as a conflict of interest•Ian F. Purcell reports no relationships that could be construed as a conflict of interest•Rajiv Das reports no relationships that could be construed as a conflict of interest•Nick Palmer reports no relationships that could be construed as a conflict of interest•Ever D. Grech reports no relationships that could be construed as a conflict of interest•Ajay Jain reports no relationships that could be construed as a conflict of interest•Gregg W. Stone has received consulting fees from Miracor.•Robin Nijveldt reports no relationships that could be construed as a conflict of interest•Thomas McAndrew reports no relationships that could be construed as a conflict of interest•Azfar Zaman has received consulting fees from Miracor.

Figures

Fig. 1
Fig. 1
Study flow diagram. CMR: cardiac magnetic resonance imaging; PiCSO: Pressure-controlled intermittent Coronary Sinus Occlusion; pPCI: primary percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction.
Fig. 2
Fig. 2
Infarct size in propensity score-matched PiCSO and control patients with STEMI who underwent pPCI. Error bars show 95% confidence intervals. PiCSO: Pressure-controlled intermittent Coronary Sinus Occlusion; pPCI: primary percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction.
See this image and copyright information in PMC

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