Efficacy and Safety of Pressure-controlled Intermittent Coronary Sinus Occlusion in STEMI: A Systematic Review and Meta-analysis
Sarim Rashid1, Hesham Naeem2, Muhammad A Aneeq3
1Department of General Surgery, Eash Lancashire NHS Hospital, Burnley, UK.
Insights
Percutaneous coronary intervention with contrast medium perfusion during STEMI (STEMI) significantly reduces infarct size and improves microvascular function. This novel technique enhances left ventricular ejection fraction in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
- Microvascular dysfunction is a key determinant of infarct size and adverse outcomes post-STEMI.
- Novel techniques are needed to optimize outcomes during percutaneous coronary intervention (PCI) for STEMI.
Purpose of the Study:
- To systematically review and assess the evidence for the use of percutaneous coronary intervention with contrast medium perfusion during STEMI (PICSO-STEMI).
- To determine the role of PICSO in improving infarct size, microvascular function, and left ventricular ejection fraction (LVEF) in STEMI patients undergoing primary PCI (PPCI).
Main Methods:
- A systematic review of relevant articles was conducted.
- Searched databases included PubMed, Embase, Cochrane Library, and Web of Science.
- Four cohort studies were included in the quantitative (pooled) analysis.
Main Results:
- PICSO use was associated with a significant reduction in infarct size (SMD = -0.44, p = 0.004).
- PICSO reduced the risk of microvascular resistance (RR = 0.75, p = 0.0051) and post-procedural Index of Microvascular Occlusion (MVO) (SMD = -0.35, p = 0.03).
- PICSO was linked to a higher LVEF at longest follow-up (SMD = 0.328, p = 0.03).
Conclusions:
- PICSO can be safely employed during PPCI in STEMI patients.
- PICSO demonstrates improved outcomes regarding infarct size, LVEF, and microvascular perfusion.
- This technique represents a promising adjunct for optimizing reperfusion therapy in STEMI.
Abstract:
This systematic review will provide a comprehensive assessment of the evidence on PICSO in STEMI patients, and it will help to determine the role of this novel technique in the management of STEMI. The review searched for the relevant articles in the PubMed, Embase, Cochrane Library, and Web of Science databases regarding PC-ICSO. Four cohort studies were eligible to be included in the quantitative analysis. In the pooled analysis, the use of PICSO was associated with a significant reduction in infarct size (SMD = -0.44, 95% CI = -0.76,-0.13, p = 0.004). PICSO administration was associated with a reduced risk of developing microvascular resistance (RR = 0.75, 95% CI = 0.62,0.92, p = 0.0051). The post-procedural Index of Microvascular Occlusion (MVO) was lower in the PICSO treated compared to the control group and this result was homogenous and statistically significant (SMD = -0.35, 95% CI = -0.68-0.01, p = 0.03, I2 = 0%). Compared to matched controls, the use of PICSO was associated with higher Left Ventricular Ejection Fraction (LVEF) at the longest follow-up (SMD = 0.328, 95% CI = 0.03, 0.06, p = 0.03, I2 = 0%). This review suggested that PICSO can be used during PPCI in STEMI with improved outcomes of infarct size, LVEF, and microvascular perfusion.
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