Bloodless Reperfusion in Acute Myocardial Infarction

Treatment of ST-elevation myocardial infarction (STEMI) by means of mechanically reperfusion has been shown to be of prognostic relevance. A downside of mechanically reperfusion is that it is often accompanied by reperfusion - or microvascular injury. Recently a promising technique to tackle reperfusion injury has been developed, bloodless reperfusion. In the current trial we will evaluate the safety and feasibility of this technique as well as evaluate intracoronary derived pressure parameters to identify microvascular injury prior to reperfusion in a STEMI population.

Treatment of ST-elevation myocardial infarction (STEMI) by means of mechanically reperfusion is often accompanied by reperfusion injury. As pre- and postconditioning in STEMI appears to be ineffective, cardioprotection should occur in parallel (perconditioning) to the sustained coronary occlusion and interact with the distal coronary arterial micro-circulation prior to epicardial restoration of flow. This is known as bloodless reperfusion and constitutes a new therapeutic strategy to tackle reperfusion injury.

The technique of bloodless reperfusion and measurement of CWP, IMR, iFR and FFR will be executed during the index procedure, the primairy PCI.

CMR will be performed at 2-7 days and 1 month follow-up

The bloodless reperfusion technique will be evuluated:

A adequately sized semi-compliant balloon will be inflated at low pressure (2-4atm) proximal to the occlusion. Thereafter a double lumen microcatheter (over-the-wire) will be advanced distal to the occlusion. Coronary wedge pressure (CWP) will be measured with a pressure wire advanced through the microcatheter. Bloodless reperfusion can also be achieved through the micocatheter.