ACC.26 – Dr Navin Kapur (Tufts Medicine, Boston, MA, US) joins us to discuss findings from the STEMI-Door To Unload (DTU) randomised clinical trial, examining whether primary left ventricular unloading with the Impella CP® device prior to reperfusion can reduce infarct size and heart failure-related outcomes in patients presenting with anterior ST-elevation myocardial infarction.

This prospective, multicentre, randomised controlled trial enrolled 527 patients with acute anterior STEMI across 63 sites in the US, Canada, Europe, and the UK. Patients were randomised to 30 minutes of LV unloading via the Impella CP® device prior to primary PCI, or primary PCI alone as standard of care. The primary endpoint was infarct size normalised to left ventricular mass, assessed by cardiac MRI at 3–5 days post-procedure, with a composite secondary efficacy endpoint — including cardiovascular mortality, cardiogenic shock, LVAD or transplant, heart failure hospitalisation, and ICD/CRT placement — evaluated at 12 months.

Interview Questions:

1. What is the rationale for primary LV unloading prior to reperfusion, and how has this concept evolved over recent years?
2. What were the key design features of the STEMI-DTU trial and how did you approach the 30-minute unloading protocol?
3. What were your primary and key secondary findings?
4. How do the results inform the use of mechanical circulatory support in the primary PCI setting?
5. What are your take-home messages for interventional cardiologists managing anterior STEMI?
6. What are the next steps for this research?

Recorded on-site at ACC Annual Scientific Session 2026, New Orleans

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Editors: Jordan Rance
Videographer:

Support: This is an independent interview produced by Radcliffe Cardiology.