Abstract 13394: Primary Perfusion Balloon Angioplasty in Primary Percutaneous Coronary Intervention for St-Segment Elevation Myocardial Infarction - The Novel Cardioprotective Revascularization Strategy

Abstract

Background: In patients with STEMI, primary PCI reduces the risk of cardiovascular death, whereases following myocardial reperfusion injury indicating poor prognosis. Post-conditioning is expected to limit reperfusion infarction but the long-term outcome is unclear. We investigated whether primary perfusion balloon angioplasty (PPBA) strategy might reduce reperfusion injury and improve prognosis. Methods: PPBA is maneuver treating as primary revascularization procedure with perfusion balloon angioplasty undergoing long-inflation (5-minutes or more) as post-conditioning. This study is a retrospective analysis from an observational registry which enrolled all consecutive 49 patients with STEMI undergoing PCI in PPBA strategy or conventional balloon angioplasty (CBA) strategy at a single center from February 2021 to January 2022. The primary outcome of the study was MACE as a composite of all-cause death, cardiac death, MI, CI-TVR, hospitalization because of heart failure, and cerebrovascular disease followed at 6 months. The secondary outcome was the composite of no-reflow or slow flow phenomenon, ST elevation, and VT or VF occurrence immediately after primary revascularization procedure. Results: 24 patients were treated with PPBA strategy and 25 patients were treated with CBA strategy. At the 6-months, primary composite outcome occurred in 25% treated with PPBA strategy and in 52% treated with CBA strategy (HR, 0.38; P=0.04); the difference was driven by a lower incidence of cardiac death, MI, CI-TVR in PPBA arm. Immediately after primary revascularization, secondary composite outcome occurred in 4.2% treated with PPBA and in 56% treated with CBA (RR, 0.03; P=0.0001); the difference was driven by a lower incidence of no-reflow/slow flow and ST elevation in PPBA arm. Conclusions: PPBA strategy as primary cardioprotective revascularization expected post-conditioning reduces lethal reperfusion injury, resulting in a better prognosis in STEMI.