Does delaying reperfusion by 30 minutes following left ventricular (LV) unloading impact safety and feasibility compared with LV unloading followed by immediate reperfusion? Findings from the Door-to-Unload (DTU) pilot study presented Nov. 11 at AHA 2018 in Chicago, IL, suggest the answer may be no on both counts.

Navin A. Kapur, MD, FACC, et al., randomized 50 patients to either LV unloading plus immediate reperfusion (U-IR) or LV unloading plus a 30-minute delay before reperfusion (U-DR). The primary safety outcome was no difference in the composite of Major Adverse Cardiovascular and Cerebrovascular Events including cardiovascular mortality, reinfarction, stroke and major vascular events at 30 days between groups. Additionally, researchers also looked at differences in infarct size normalized as a percent of total LV mass at 30 days between the two groups.

Overall results found no increase in the primary safety outcome between the two groups. Additionally, LV unloading first then delaying reperfusion for 30 minutes did not increase infarct size, researchers said. They also noted that "among patients with sum STE>6mm, infarct size normalized to the area at risk was significantly lower with 30 minutes of LV unloading before reperfusion" compared with U-IR.

Based on the pilot findings, Kapur and colleagues said there are no "prohibitive safety signals" that would preclude moving forward with a larger study of LV U-DR.

Keywords: AHA18, AHA Annual Scientific Sessions, Heart Ventricles, Myocardial Reperfusion

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