Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study

Mohaned Egred; Alan Bagnall; Ioakim Spyridopoulos; Ian F Purcell; Rajiv Das; Nick Palmer; Ever D Grech; Ajay Jain; Gregg W Stone; Robin Nijveldt; Thomas McAndrew; Azfar Zaman

doi:10.1016/j.ijcha.2020.100526

Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study

Int J Cardiol Heart Vasc. 2020 May 15:28:100526. doi: 10.1016/j.ijcha.2020.100526. eCollection 2020 Jun.

Authors

Affiliations

¹ Freeman Hospital, Newcastle upon Tyne, UK.
² Liverpool Heart and Chest Hospital, Liverpool, UK.
³ Northern General Hospital, Sheffield, UK.
⁴ St. Bartholomew's Hospital, London, UK.
⁵ Cardiovascular Research Foundation, New York, NY, USA.
⁶ Radboud University Medical Center, Nijmegen, Netherlands.

Abstract

Background: The aim of this clinical research was to investigate the effects of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size at 5 days after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods and results: This comparative study was carried out in four UK hospitals. Forty-five patients with anterior STEMI presenting within 12 h of symptom onset received pPCI plus PiCSO (initiated after reperfusion; n = 45) and were compared with a propensity score-matched control cohort from INFUSE-AMI (n = 80). Infarct size (% of LV mass, median [interquartile range]) measured by cardiac magnetic resonance (CMR) at day 5 was significantly lower in the PiCSO group (14.3% [95% CI 9.2-19.4%] vs. 21.2% [95% CI 18.0-24.4%]; p = 0.023). There were no major adverse cardiac events (MACE) related to the PiCSO intervention.

Conclusions: PiCSO, as an adjunct to pPCI, was associated with a lower infarct size at 5 days after anterior STEMI in a propensity score-matched population.

Keywords: ACS, acute coronary syndrome; AMI, acute myocardial infarction; BARC, Bleeding Academic Research Consortium; CI, Confidence interval; CMR, Cardiac magnetic resonance; CRT, Cardiac Resynchronization Therapy; IMR, Index of microcirculatory resistance; Infarct size reduction; LAD, left anterior descending artery; LV, Left ventricle; MACE, Major adverse cardiac events; PiCSO, Pressure-controlled intermittent coronary sinus occlusion; Pressure-controlled intermittent coronary sinus occlusion (PICSO); SD, Standard deviation; ST-segment elevation myocardial infarction (STEMI); STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombosis in myocardial infarction; pPCI, Primary percutaneous coronary intervention.