Gradual Versus Abrupt Reperfusion in Primary PCI (GUARD)
ST-elevation Acute Myocardial Infarction
About this trial
This is an interventional treatment trial for ST-elevation Acute Myocardial Infarction focused on measuring primary percutaneous coronary intervention, microvascular obstruction, myocardial edema, microvascular resistance, acute myocardial infarction
Eligibility Criteria
Inclusion Criteria:
- Patients presenting with ST-elevation acute myocardial infarction (STEMI) within 12 hours of their symptom onset in whom TIMI-3 flow was established in infarct related artery (IRA) after balloon angioplasty or thrombectomy.
Exclusion Criteria:
- Recanalized (TIMI I-III flow) IRA at coronary angiography.
- Patients in whom TIMI-3 flow was not able to be established after wire crossing, balloon angioplasty or thrombectomy.
- STEMI due to bypass-graft occlusion
- Severe heart failure or cardiogenic shock
Sites / Locations
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology
- Istanbul University School of Medicine
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Deferred coronary stenting
Immediate stenting
In this arm, after establishing TIMI -3 flow in infarct related artery with balloon angioplasty, patients will undergo stent implantation when coronary autoregulatory function was recovered (initial hyperemic flow was subsided and baseline resistance was increased). Recovery of the auto regulatory function will be determined by measuring microvascular flow and resistance. After stenting microvascular flow / resistance will continue to be monitored using pressure/flow sensor tipped guide wire until the completion of 1 hour follow up period.
In this arm, patients will undergo stenting immediately after balloon angioplasty. After stent implantation, microvascular flow / resistance values will be continuously monitored using pressure/flow sensor tipped guide wire until the end of 1 hour follow up period.