Supersaturated Oxygen Therapy for Coronary Microvascular Dysfunction in Patients With ST-Segment Elevation Myocardial...

Supersaturated oxygen (SSO₂) therapy is a new therapy that reduces infarct size and improves myocardial remodeling after successful revascularization by percutaneous coronary intervention (PCI). An action mode via the improvement of coronary microvascular dysfunction (CMD) is suggested; however, the device requires a femoral puncture and keeping the patient in the interventional room for 60 minutes. Thus, the development of stratified medicine via CMD severity could be of interest. This study sought to investigate the action of SSO₂ therapy on CMD in patients with anterior ST-segment elevation myocardial infarction (STEMI).

In a prospective pilot study, consecutive patients with acute anterior STEMI undergoing primary PCI were enrolled. After successful PCI of a proximal lesion or middle left anterior descending artery, SSO₂ therapy was performed. Blood was drawn from a femoral artery sheath (5F catheter), hyper-oxygenated by SSO₂ therapy, and delivered to the origin of the left anterior descending artery a via a dedicated catheter by radial artery (6F catheter). Improvement in CMD was assessed by comparing the angiography-derived index of microcirculation resistance (Angio-IMR) before and after 60 minutes of SSO₂ therapy measured on conventional angiographic images. ΔAngio-IMR was calculated as Angio-IMR before SSO₂ - angio-IMR after SSO₂.

Twelve patients (all men; mean age, 64 [59-69] years) successfully completed the procedure. No complications were noted during the SSO₂ procedure. Median Angio-IMR before SSO₂ was 44.5 (32.5-52.5) and median Angio-IMR after SSO₂ was 23 (20-30.5); P = .003. ΔAngio-IMR was statistically different between patients with or without Angio-IMR >40 at baseline (25 [16.2-29.7.5] vs 4.5 [1-11]; P = .004).

In patients with anterior STEMI, SSO₂ improves CMD measured by angio-IMR. Only patients with high Angio-IMR at baseline (>40) presented a significant decrease. These results need to be confirmed with more data, and thus, Angio-IMR could help to develop stratified medicine to use SSO₂ in anterior STEMI patients with severe CMD.