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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Initial experience with hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction

Results of a pilot study utilizing intracoronary aqueous oxygen therapy

Simon R. Dixon, MBChB, FRACP^*, Antonio L. Bartorelli, MD, FACC, Pamela A. Marcovitz, MD, FACC^*, Richard Spears, MD, FACC, Shukri David, MD, FACC, Issac Grinberg, MD, FACC, Mansoor A. Qureshi, MD^*, Mauro Pepi, MD, Daniela Trabattoni, MD, Franco Fabbiocchi, MD, Piero Montorsi, MD and William W. O’Neill, MD, FACC^*,*

^* Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
Centro Cardiologico Fondazione Monzino IRCCS, Istituto di Cardiologia Università di Milano, Milan, Italy
Providence Hospital and Medical Center, Southfield, Michigan, USA

Manuscript received May 14, 2001; revised manuscript received October 10, 2001, accepted October 31, 2001.

^* Reprint requests and correspondence: Dr. William W. O’Neill, Division of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA.
woneill{at}beaumont.edu

OBJECTIVES: The purpose of this study was to evaluate the feasibility and safety of intracoronary hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction (MI).

BACKGROUND: Hyperoxemic therapy with aqueous oxygen (AO) attenuates reperfusion injury and preserves left ventricular (LV) function in experimental models of MI.

METHODS: In a multi-center study of patients with acute MI undergoing primary angioplasty (PTCA), hyperoxemic blood (pO₂: 600 to 800 mm Hg) was infused into the infarct-related artery for 60 to 90 min after intervention. The primary end points were clinical, electrical and hemodynamic stability during hyperoxemic reperfusion and in-hospital major adverse cardiac events. Global and regional LV function was evaluated by serial echocardiography after PTCA, after AO infusion, at 24 h and at one and three months.

RESULTS: Twenty-nine patients were enrolled (mean age: 58.9 ± 12.6 years). Hyperoxemic reperfusion was performed successfully in all cases (mean infusion time: 80.8 ± 18.2 min; mean coronary perfusate pO₂: 631 ± 235 mm Hg). There were no adverse events during hyperoxemic reperfusion or the in-hospital period. Compared with baseline, a significant improvement in global wall motion score index was observed at 24 h (1.68 ± 0.24 vs. 1.48 ± 0.24, p < 0.001) with a trend toward an increase in ejection fraction (48.6 ± 7.3% vs. 51.8 ± 6.8%, p = 0.08). Progressive improvement in LV function was observed at one and three months, primarily due to recovery of infarct zone function.

CONCLUSIONS: Intracoronary hyperoxemic reperfusion is safe and well tolerated after primary PTCA. These preliminary data support the need for a randomized controlled trial to determine if hyperoxemic reperfusion enhances myocardial salvage or improves long-term outcome.

Abbreviations and Acronyms   AMI   acute myocardial infarction   AO   aqueous oxygen   BP   blood pressure   EF   ejection fraction   LV   left ventricle   PTCA   percutaneous transluminal coronary angioplasty   TIMI   Thrombolysis In Myocardial Infarction   WMSI   wall motion score index

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