Abstract 2854: RAPID (Reperfusion with Aspiration or Pulse Infusion thrombolysis prior to Direct PCI for AMI) Trial
We have reported that pulse infusion thrombolysis (PIT) prior to percutaneous coronary intervention (PCI) may be an effective strategy for preventing no reflow during reperfusion therapy for acute myocardial infarction (AMI), especially with large coronary thrombus. The RAPID trial was a prospective randomized trial at 14 institutions enrolling 105 patients with ST-segment elevation myocardial infarction. Patients were randomized to receive PCI after PIT with t-PA (PIT Group, n=56) vs PCI after aspiration/distal protection(Suction Group, n=49). Clinical and angiographic outcomes between both groups were compared. Baseline clinical characteristics and infarct locations were balanced. TIMI 3 flow and Blush score 3 after PIT or aspiration were obtained significantly earlier in the PIT Group than in the Suction Group (TIMI 3 flow: 59% vs 40%, p<0.05; Blush score 3: 59% vs 12%, p=0.003). The number of final TIMI 3 flow after PCI was not significantly different between the two groups (89.0% in PIT vs 90% in Suction); however, those patients having final blush score 3 were significantly higher in the PIT Group than in the Suction Group (89.0 % vs 48.8%, p<0.05). The incidence of major adverse cardiac events, bleeding complications and/or maximum CPK levels during admission were not different between the groups.
Conclusions: PIT or aspiration may be an effective strategy to restore the epicardial coronary flow; furthermore, PIT may be more effective to restore myocardial microperfusion in AMI.