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Diagnostic Ultrasound with contrast agent for non-invasive treatment for Heart Attack

Professor Kazuaki Negishi, Institution: University of Sydney

2018 Vanguard Grant

Years funded: 2019-2021


Heart disease is the single leading cause of death in Australia and heart attack (i.e. acute myocardial infarction) is a life-threatening event. It claimed 8,623 Australian lives in 2014 (i.e. 24 deaths/day).
Heart attack requires emergent intervention to restore the blood flow. Fibrinolysis is recommended in Australia, and worldwide, when primary percutaneous coronary intervention (pPCI, so-called “stent” therapy) cannot be performed < 90 min of first medical contact. The fibrinolysis therapy uses a drug injection aiming to restore flow by dissolving the blood clot blocking the heart artery. In Australia, many patients are a long way from a pPCI centre, and these patients usually receive fibrinolysis in hospitals that are not PCI-capable.

Unfortunately, the success rate of fibrinolysis alone is suboptimal, where only 54% are restored to normal flow. This is critically important because 30-day survival among patients with normal flow is twice that of patients with no flow.

Recently, small pilot studies in humans show that a new technique called sonothrombolysis (adding a combination of diagnostic ultrasound with contrast agents to the fibrinolysis) can dissolve the clot at much higher success rate (~ x3) than fibrinolysis only, reduces the heart damage, and improves heart function.

These findings are promising but there has never been a randomised controlled trial (RCT), which is what we propose in this current application. We will perform a pilot RCT to assess the efficacy of this method. If successful, this result will be used to inform the design of a large, multicentre NHMRC clinical trial grant application.

The potential is huge because this method would help many lives who live remote areas or with limited access to a 24/7 PCI centre, as this method could open the heart artery at a much earlier stage. In future, patients can receive this therapy in the ambulance on their way to hospital because this therapy only requires ultrasound and contrast agents.

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