Acute Myocardial Infarction With ST Elevation Clinical Trial
Official title:
A Randomized Study to Evaluate Controlled Reperfusion With Venous Blood and Dextran for Myocardial Protection Compared With Standard Angioplasty During Primary Angioplasty in Patients With Acute Myocardial Infarction and TIMI 0/1 Flow.
Reperfusion therapy in acute myocardial infarction saves viable myocardium, but paradoxically reestablishment of coronary artery flow also induces damage and cell death, decreasing the full benefit of reperfusion in terms of reduction of infarct size and preservation of ventricular function . Myocardial reperfusion can in itself produce more damage and cell death, this process defines the phenomenon of reperfusion injury, which could be prevented by applying additional therapies.
During myocardial ischemia, due to lack of O2, the myocyte leaves energy production from the
aerobic metabolism of lipids and the production of energy in the form of phosphates will
depend, in this situation, on the anaerobic metabolism of glucose. As a result they are
consumed muscle glycogen stores that produce little ATP, and also generating acidosis. The
cell membrane loses its ability to maintain the fluid's electrolyte balance. Cellular edema
is generated by the entry of sodium and water, leading to cell rupture. During ischemia and
reperfusion free radicals are produced that stimulate inflammation and consequently release
prothrombotic and cytotoxic substances that also produce cellular damage. Due to its
osmotic, antithrombotic, anti-inflammatory and rheological effects, dextran could be useful
in this scenario.
The administration of a solution in the distal bed, for the protection of the myocardium,
before opening the epicardial artery is called by us "controlled reperfusion". The
researchers think, using a solution with venous blood, containing less O2 but retaining
buffer properties; enriched with Dextran, which has onctic power, anti-inflammatory and
anticoagulant properties, and molecules similar to glucose; results in a potentially useful
solution for myocardial protection in this scenario.
The group of investigators expect that controlled reperfusion treatment will reduce the
incidence of ST correction and infarct size by 20-30%, improving the prognosis in terms of
mortality and heart failure.
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