Sonothrombolysis in the ambulance for ST-elevation myocardial infarction: rationale and protocol
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Neth Heart J https://doi.org/10.1007/s12471-020-01516-9
Sonothrombolysis in the ambulance for ST-elevation myocardial infarction: rationale and protocol S. El Kadi · T. R. Porter · A. C. van Rossum · O. Kamp
Accepted: 20 October 2020 © The Author(s) 2020
Abstract Background Treatment of ST-elevation myocardial infarction (STEMI) has improved over the years. Current challenges in the management of STEMI are achievement of early reperfusion and the prevention of microvascular injury. Sonothrombolysis has emerged as a potential treatment for acute myocardial infarction, both for epicardial recanalisation as well as improving microvascular perfusion. This study aims to determine safety and feasibility of sonothrombolysis application in STEMI patients in the ambulance. Methods Ten patients with STEMI will be included and treated with sonothrombolysis in the ambulance during transfer to the PCI centre. Safety will be assessed by the occurrence of ventricular arrhythmias and shock during sonothrombolysis intervention. Feasibility will be assessed by the extent of protocol completion and myocardial visibility. Efficacy will be determined by angiographic patency rate, ST-elevation resolution, infarct size and left ventricular volumes, and function measured with cardiovascular magnetic resonance imaging, and contrast and strain echocardiography. A comparison will be made with matched controls using an existing STEMI database. Discussion Sonothrombolysis is a novel technique for the treatment of cardiovascular thromboembolic disease. The first clinical trials on its use for STEMI have demonstrated promising results. This study will be the first to examine the feasibility of in-ambulance sonothrombolysis for STEMI. S. El Kadi () · A. C. van Rossum · O. Kamp Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands [email protected] T. R. Porter Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
Trial registration EU Clinical Trials Register (identifier: 2019-001883-31), registered 2020-02-25. Keywords Sonothrombolysis · ST-elevation myocardial infarction · Ambulance · Treatment
Background ST-segment elevation on the electrocardiogram (ECG) indicates the occlusion of an epicardial coronary artery, most commonly due to thrombus formation at the site of a ruptured atherosclerotic plaque. The optimal treatment strategy for ST-elevation myocardial infarction (STEMI) is immediate restoration of epicardial coronary blood flow. Currently, primary percutaneous coronary intervention (PCI) with concomitant dual antiplatelet therapy and periprocedural anticoagulation constitutes the treatment of choice in STEMI patients [1]. While successful reperfusion has led to a marked decrease in annual deaths over the past decades, long-term mortality and morbidity remain substantial [2, 3]. In addition to prolonged ischaemia and subsequent infarct size, microvascular injury due to ischaemic and reperfusion processes is a major determinant o
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