TCT-34 Reduction of Infarct Size in Anterior ST-Segment Elevation Myocardial Infarction (STEMI) With LAD Occlusion and LV Unloading Using a Micro-axial Pump for 30 Minutes Before PCI: Per-Protocol Analysis of the STEMI Door to Unload (DTU) Pilot Study
Kapur N, Moses J, Faraz H, George Z, Iyer V, Karas R, Kimmelstiel C, Koenig G, Madder R, Meraj P, Kim R, Schreiber T, Wohns D, Udelson J, Stone G, and O'Neill W. TCT-34 Reduction of Infarct Size in Anterior ST-Segment Elevation Myocardial Infarction (STEMI) With LAD Occlusion and LV Unloading Using a Micro-axial Pump for 30 Minutes Before PCI: Per-Protocol Analysis of the STEMI Door to Unload (DTU) Pilot Study. J Am Coll Cardiol 2022; 80(12):B14-B15.
J Am Coll Cardiol
Background: The STEMI-DTU pilot trial identified that LV unloading before PCI is safe and feasible in anterior STEMI without shock. We now report findings from patients who met all protocol inclusion and exclusion criteria.
Methods: In a multicenter, randomized safety and feasibility trial, 50 patients with anterior STEMI were unloaded using the Impella CP followed by immediate (U-IR) or delayed PCI after 30 minutes of unloading (U-DR). Cardiac magnetic resonance (CMR) imaging assessed infarct size 3-5 days after PCI. Patients without CMR at 3-5 days (n = 10; 5/arm), without PCI of a culprit LAD lesion (n = 2; 1/arm) and without STEMI (n = 5; 4 U-IR, 1 U-DR) were not per protocol and thus excluded.
Results: 33 patients met all inclusion and exclusion criteria (U-IR n = 15, U-DR n = 18) with respective door-to-balloon times of 75 ± 26 and 89 ± 23 minutes (P = 0.10) and mean unload-to-balloon times of 10 ± 5 and 34 ± 3 (P < 0.01). In the total cohort 2-5 day IS was significantly associated with microvascular obstruction (MVO), 30-day IS normalized to total LV mass, 90 day LVEF, and 90 day LV end systolic volume with or without delayed reperfusion (Table) (R > 0.5, P < 0.005 for all). Despite longer symptom to balloon times in the U-DR arm (174 ± 59 vs 228 ± 78, P < 0.01) IS/AAR was lower in the U-DR arm (62 ± 16 vs 48 ± 16, P = 0.04) and remained lower irrespective of STE magnitude. MVO was lower in the U-DR arm among patients with the highest STE (Figure).
Conclusion: A per-protocol analysis of the STEMI-DTU Pilot trial identified reduced infarct size with unloading and delayed reperfusion. These findings are under investigation in the STEMI-DTU Pivotal trial.
Categories: CORONARY: Acute Myocardial Infarction