What is the STEMI-DTU trial?

 

STEMI stands for ‘ST-segment Elevation Myocardial Infarction’ and DTU refers to ‘Door To Unloading’.

The current guideline recommended therapy for acute myocardial infarction (AMI) due to occlusion of a coronary artery is rapid revascularization to enable primary coronary reperfusion and limit infarct size.1 However, reperfusion of an occluded artery also contributes to reperfusion injury and increases infarct size.2

Recent pre-clinical studies suggest that primary ventricular unloading using LV assist devices such as Impella prior to coronary reperfusion reduces infarct size.1,3

The STEMI-DTU feasibility trial (NCT03000270) was a multicenter, prospective, randomized trial to assess the impact of primary unloading with Impella CP prior to revascularization on infarct size in patients with anterior wall STEMI. Patients with cardiogenic shock were not included in the trial.

References:

  1. Esposito ML, Zhang Y, Qiao X, et al. Left Ventricular Unloading Before Reperfusion Promotes Functional Recovery After Acute Myocardial Infarction. J Am Coll Cardiol. 2018;72(5):501-514.
  2. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med 2007;357:1121–35.
  3. Kapur NK, Qiao X, Paruchuri V, et al. Mechanical preconditioning with acute circulatory support before reperfusion limits infarct size in acute myocardial infarction. J Am Coll Cardiol HF 2015;3:873–82.

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