Impact of intracoronary contrast injection pressure on reperfusion during primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: A prospective randomized pilot study
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Updated: Jan 20, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Kresimir Stambuk1, Tomislav Krcmar2, Ivan Zeljkovic2
1Clinic for Cardiovascular Medicine, Hospital for Cardiovascular Surgery and Cardiology Magdalena, Ljudevita Gaja 2, 49217 Krapinske Toplice, Croatia.
Insights
Lower contrast injection pressure during primary PCI for STEMI did not impact myocardial reperfusion. This pilot trial found no significant difference in myocardial blush grade or ST-segment changes between higher and lower pressure groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction
Background:
- Distal embolization of plaque and thrombotic debris in the infarct-related artery (IRA) can cause microvascular obstruction and impair myocardial reperfusion.
- Acute ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion to minimize myocardial damage.
Purpose of the Study:
- To assess the impact of contrast injection pressure in the IRA during primary percutaneous coronary intervention (PCI) on myocardial reperfusion in STEMI patients.
- To determine if higher or lower contrast injection pressures influence the success of reperfusion therapy.
Main Methods:
- Prospective, randomized, open-label pilot trial involving 100 acute STEMI patients undergoing primary PCI.
- Patients were randomized into two groups: higher injection pressure (550 psi) or lower injection pressure (200 psi).
- The primary endpoint was the postprocedural incidence of restored myocardial perfusion, defined as myocardial blush grade (MBG) 3.
Main Results:
- No significant difference in the incidence of MBG 3 between the higher (33 patients) and lower (36 patients) injection pressure groups (p=0.247).
- No significant differences were observed in ST-segment deviation scores immediately after or 24 hours post-primary PCI between the groups.
- Baseline characteristics were similar across both groups, indicating successful randomization.
Conclusions:
- Intracoronary contrast injection pressure during primary PCI in STEMI patients does not significantly impact myocardial reperfusion as assessed by MBG or ST-segment changes.
- The findings suggest that contrast injection pressure is not a critical factor in achieving successful reperfusion in this setting.
- Further research may be warranted to explore other factors influencing microvascular obstruction and reperfusion outcomes.
Background:
Distal embolization of plaque and thrombotic debris in the infarct-related artery (IRA) may lead to microvascular obstruction resulting in impaired myocardial reperfusion.The aim of the study was to assess the impact of contrast injection pressure in IRA, during primary percutaneous coronary intervention (PCI), on myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI).
Methods:
This prospective, randomized, open label, pilot trial evaluated acute STEMI patients who underwent primary PCI, with blinded evaluation of end points. Patients were assigned to higher injection pressure group A (550 pound/inch2) or lower injection pressure group B (200 pound/inch2). Primary endpoint was the postprocedural incidence of restored myocardial perfusion defined as myocardial blush grade (MBG) 3.
Results:
Study included 100 consecutive acute STEMI patients, with median age of 63 (56-72) years (77% men) who were randomized to higher and lower injection pressure group. Baseline demographic, clinical and angiographic characteristics did not differ significantly between the groups. There were no significant differences between the study groups regarding difference in achieved MBG 3 (33 vs 36 patients, p = 0.247) nor regarding the ST-segment deviation score neither immediately after (3 vs 4 mm, p > 0.3) nor 24 h after primary PCI (2 vs 3 mm, p > 0.3).
Conclusion:
There was no impact of lower intracoronary contrast injection pressure in comparison to higher injection pressure, during primary PCI in patients with acute STEMI, on myocardial reperfusion as assessed by MBG or ST segment changes in the ECG.The study was registered at registry ClinicalTrials.gov with the registration number: NCT03445364, on February 26th 2018.
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