This prospective, randomized study was designed to evaluate whether the noninvasive artificial venous stasis / RE-START procedure, administered prior to primary percutaneous coronary intervention, increases the frequency of spontaneous coronary reperfusion in the infarct-related artery.

The primary hypothesis of the study is that the application of short-term, controlled venous return restriction via a blood pressure cuff on the non-dominant arm may support thrombus lysis by stimulating endothelial-derived fibrinolytic activity and may increase the rate of spontaneous reperfusion, defined as TIMI 2 or TIMI 3 flow, in the infarct-related artery prior to primary percutaneous coronary intervention.

This study seeks to answer the following key question: In patients with acute STEMI, does the RE-START procedure-administered without delaying standard care or the preparation process for primary percutaneous coronary intervention-increase the incidence of spontaneous coronary reperfusion prior to primary percutaneous coronary intervention compared to a sham/control procedure?

Inclusion Criteria:

• Having presented within the first 12 hours of symptom onset Being hemodynamically stable (Killip Class I-II)

  • STEMI diagnosis confirmed by coronary angiography
  • Primary PCI (percutaneous coronary intervention) scheduled
  • No pathology in the upper extremity that would prevent cuff application
  • Be capable of providing informed consent and provide consent

Exclusion Criteria:

• Presence of cardiogenic shock (systolic blood pressure < 90 mmHg and Killip Class III-IV)

  • Cardiac arrest occurring before or after the procedure
  • Need for resuscitation following failed thrombolysis
  • History of prior coronary artery bypass surgery
  • Concurrent acute aortic dissection
  • Venous thromboembolism or pulmonary embolism
  • History of an acute infection within the past 7 days
  • Chronic kidney disease requiring erythropoietin therapy or currently undergoing hemodialysis
  • Presence of liver failure or a hematologic disorder
  • Presence of any chronic inflammatory or autoimmune disease
  • History of any known malignancy (cancer)
  • Current treatment with glibenclamide, corticosteroids, antioxidant vitamins, or cyclosporine at the time of enrollment
  • History of chronic (daily) alcohol consumption
  • Contraindications to aspirin and/or clopidogrel
  • Failure to confirm a STEMI diagnosis via coronary angiography
  • Inability to provide informed consent
  • Pregnancy
  • First 6 months postpartum Conditions in which the administration of thrombolytics is contraindicated

The study population will include adult patients admitted to Firat University Hospital with acute ST-segment elevation myocardial infarction who are eligible for and planned to undergo primary percutaneous coronary intervention. Eligible patients will be randomized before coronary angiography to either the RE-START procedure group or the sham-control group, without delaying standard STEMI management or primary PCI.