Clinical Research Directory

Reducing Slow/No-Reflow With Prophylactic High-Dose Intracoronary Adenosine Protocol in ST-Elevation Myocardial Infarction The REFLOW AMI Trial

The REFLOW AMI Trial aims to determine whether prophylactic high-dose intracoronary adenosine reduces slow-flow or no-reflow (SNR) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Slow-flow or no-reflow occurs when blood flow to the heart muscle remains reduced despite treatment of the blocked coronary artery. This complication can lead to greater heart muscle damage and worse clinical outcomes. The study will evaluate a protocol involving 200 micrograms of intracoronary adenosine administered before each balloon or stent inflation during PPCI. Researchers will compare outcomes with standard PPCI care without prophylactic adenosine. The main questions the study aims to answer are: * Does prophylactic intracoronary adenosine reduce the incidence of slow-flow or no-reflow after PPCI? * Does the protocol improve post-PCI coronary blood flow, assessed by TIMI flow grade and myocardial blush grade? * What are the rates of major adverse cardiovascular events (MACE) during hospitalization and at 30 days? * Does the protocol affect left ventricular ejection fraction (LVEF) at discharge and at 30 days? * Does the protocol improve functional capacity at 30 days, assessed by the six-minute walk test? * Is the prophylactic adenosine protocol safe? Participants will undergo PPCI according to their assigned study group and will be assessed for angiographic outcomes, safety events, and clinical outcomes during hospitalization and follow-up, including at 30 days.

Intracoronary Hypothermia as a Prevention of Reperfusion Injury in Myocardial Infarction.

Acute myocardial infarction with ST segment elevation is often accompanied by a totally occluded coronary artery. Which has deleterious effects on heart muscle. Primary percutaneous coronary intervention is the most effective mode of treatment for ST-elevation myocardial infarction (STEMI) patients. Despite the restoration of the blood flow, 30-60% of patients develop microvascular obstruction, which lowers the effects of the coronary blood flow restoration. The most advanced coronary microvascular obstruction presents as a no-reflow phenomenon, which is an abrupt deceleration or absence of coronary flow following stent implantation. Several pharmacological treatments have been proposed, as well as deferred stenting, but none of them really helped. Thus, new ways of alleviating coronary obstruction are warranted. One of the new ways of mitigating the reperfusion injury is intracoronary hypothermia, which showed to be safe on a handful of patients in small series. In the animal studies, intracoronary hypothermia demonstrated a protective effect in terms of reducing infarct area. But clinical studies failed to reproduce the protective effects of intracoronary hypothermia. Thus, our study, using a modified hypothermia protocol, will test the hypothermia hypothesis.

Platelet Derived Growth Factor Receptor ß (PDGFRß) Imaging in Cardiac Fibrosis

An observational, cross-sectional, longitudinal, microdosing Position Emission Tomography (PET) imaging study to investigate platelet derived growth factor receptor beta (PDGFRß) expression in the heart of patients with high or low risk of heart failure after a ST-Elevation Myocardial Infarction (STEMI) after a percutaneous coronary intervention (PCI) with a stent procedure, as well as in patients with heart failure with preserved ejection fraction (HFpEF) and healthy individuals.