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IntraCoronary Artery Retrograde Thrombolysis vs. Thrombus Aspiration in ST-Segment Elevation Myocardial Infarction:

Mingzhi Shen1,2, Jihang Wang1, Dongyun Li3

  • 1Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China.

Frontiers in Cardiovascular Medicine
|October 3, 2022
PubMed

Insights

Intracoronary artery retrograde thrombolysis (ICART) may improve myocardial perfusion in ST-segment elevation myocardial infarction (STEMI) patients more effectively than standard treatments. This randomized trial compares ICART to thrombus aspiration or PTCA in STEMI patients undergoing primary PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Myocardial Infarction Treatment

Background:

  • Type 2 diabetes (T2DM) is a significant risk factor for myocardial infarction.
  • Routine thrombus aspiration is increasingly found to be non-beneficial for acute myocardial infarction.
  • Evaluating novel reperfusion strategies is crucial for STEMI patients.

Purpose of the Study:

  • To compare the efficacy of Intracoronary Artery Retrograde Thrombolysis (ICART) against thrombus aspiration or percutaneous transluminal coronary angioplasty (PTCA).
  • To assess the impact on myocardial perfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).

Main Methods:

  • A single-center, prospective, randomized open-label trial with blinded endpoint evaluation.
  • 286 STEMI patients undergoing PPCI were randomized into ICART and thrombus aspiration or PTCA groups.
  • Primary endpoint: >70% ST-segment elevation resolution; Secondary: distal embolization, myocardial blush grade, TIMI flow, bleeding.

Main Results:

  • The study is the first RCT to evaluate ICART versus thrombus aspiration or PTCA in STEMI patients undergoing PPCI.
  • Results regarding the primary and secondary endpoints are pending or will be presented upon study completion.

Conclusions:

  • The ICART trial aims to provide critical evidence on a novel reperfusion strategy for STEMI.
  • Findings will inform clinical practice regarding optimal treatment for acute myocardial infarction.
Abstract

Keywords:
ST-segment elevation myocardial infarctionintracoronary artery retrograde thrombolysispercutaneous coronary intervention (PCI)reperfusion preconditioningthrombus aspiration

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