Miracor Medical has announced the first patient enrolled in the PICSO-AMI-V study to evaluate PiCSO—pressure-controlled intermittent coronary sinus occlusion—therapy as an adjunct to conventional primary percutaneous coronary intervention (PCI) for patients presenting with inferior ST-Elevation Myocardial Infarction (STEMI).
The first patient enrolled was treated at the University Hospital of Toulouse (Toulouse, France) by the team of Didier Carrié.
“Our team started using the PiCSO therapy for anterior STEMI patients in 2021. We are delighted to explore new indications and now start using PiCSO for inferior STEMI patients in the context of the PiCSO-AMI-V study,” says Carrié.
The principal investigator of the study is Adrian Banning, Oxford Heart Center, Oxford, UK.
“We are pleased to be initiating the PiCSO-AMI-V study. It will explore the potential for PiCSO therapy to improve the outcomes of patients with heart attacks affecting the inferior side of the heart. The study builds upon the data from the First-InMan study that we published in 20213. We know that improving outcomes for patients with large heart attacks remains an important unmet need, especially because these patients often progress to develop heart failure,” says Banning.
PICSO-AMI-V is a prospective, randomised, multicentre feasibility study and will enrol 75 inferior STEMI patients presenting with TIMI 0 & 1 flow, at up to 10 clinical sites in Europe.
In the study, patients will be randomised 2:1 to a group receiving PiCSO as an adjunct to their primary PCI procedure versus a conventional strategy of primary PCI alone. Adverse Device Effect (ADE) rate at 30 days post index procedure will be assessed as the primary endpoint. In addition, cardiac function and clinical safety endpoints – including death, heart failure-related hospitalisation, new onset or worsening of heart failure—will be assessed.
The patients will be followed for one year. PiCSO therapy has demonstrated positive results in several clinical studies, Miracor Medical said in a press release. Data from two recent studies—PiCSO in ACS and OxAMI-PICSO—showed that the use of the PiCSO Impulse system is associated with a significant infarct size reduction in anterior STEMI patients.
Furthermore, OxAMI-PICSO3 showed an early improvement in coronary microvascular function post PiCSO treatment in both anterior and inferior STEMI patients. PiCSO therapy accelerates the microcirculatory recovery resulting in significantly lower IMR (Index of Microcirculatory Resistance) and RRR (Resistive Reserve Ratio) post procedure when compared with controls.
“We are thrilled to start this second randomised clinical trial in Europe, and to progress our strategy to expand indications beyond our initial indication of anterior STEMI. The PiCSO-AMI-V Inferior STEMI study will complement the ongoing PiCSO-AMI-I (Anterior STEMI) study, which has enrolled more than 100 anterior STEMI patients and is anticipated to complete enrolment during the second semester of this year. We also recently treated the 300th patient with the PiCSO therapy, illustrating the acceleration of usage and experience with the therapy,” says Olivier Delporte, CEO of Miracor Medical.
PiCSO therapy is used during the primary PCI procedure in acute myocardial infarct (AMI). Via its differentiated mechanism of action the PiCSO Impulse system clears the coronary microcirculation by intermittently occluding the coronary sinus outflow. The use of the PiCSO Impulse system has been associated with a reduction in infarct size after STEMI, which has been shown to lead to reductions in heart failure hospitalizations and reduced mortality. Heart Failure develops in 18‒28% of patients 90 days after their STEMI.
