Published online before print June 30, 2003, doi: 10.1161/01.CIR.0000079223.47421.78
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:171.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Mechanical Prevention of Distal Embolization During Primary Angioplasty
Safety, Feasibility, and Impact on Myocardial Reperfusion
From the Cardiac and Thoracic Department (U.L., A.M., M.D.C., G.A., R.R., C.P., V.D.B., A.S.P., M.M.) and Department of Oncology, Transplants and New Technologies in Medicine (G.F.), University of Pisa, Italy.
Correspondence to Ugo Limbruno, MD, Cardiac and Thoracic Department, Cisanello Hospital, Via Paradisa 2, 56124, Pisa, Italy. E-mail ulimbru{at}tin.it
Background— Effective myocardial reperfusion after primary percutaneous coronary intervention (PCI) may be limited by distal embolization. We tested the safety, feasibility, and efficacy of the FilterWire-Ex (FW), a distal embolic protection device, as an adjunct to primary PCI.
Methods and Results— Fifty-three consecutive patients undergoing primary PCI with FW protection were compared with a matched control group treated by primary PCI alone. Successful FW positioning was obtained in 47 patients (89%) without complications. Histological analysis of the content of the last 13 filters showed multiple embolic debris in all cases. FW use was associated with lower postinterventional corrected TIMI frame count (22±14 versus 31±19; P=0.005) and higher occurrence of grade 3 myocardial blush (66% versus 36%; P=0.006) and early ST-segment elevation resolution (80% versus 54%; P=0.006). At multivariate analysis, FW use was the only independent predictor of early ST-segment elevation resolution and of grade 3 myocardial blush. FW patients showed lower peak creatine kinase-MB release (236±172 versus 333±219 ng/mL; P=0.013) and greater improvement at 30 days in left ventricular wall motion score index (-0.30±0.19 versus -0.18±0.26; P=0.008) and ejection fraction (+7±4% versus +4±7%; P=0.012).
Conclusions— FW use during primary PCI is feasible and safe. Distal embolization prevention appears to exert a beneficial effect on markers of myocardial reperfusion and on left ventricular function improvement at 30 days.
Key Words: myocardial infarction • angioplasty • embolism • reperfusion
This article has been cited by other articles:
 |
|
 |
|
  G. Heusch, P. Kleinbongard, D. Bose, B. Levkau, M. Haude, R. Schulz, and R. Erbel Coronary Microembolization: From Bedside to Bench and Back to Bedside Circulation, November 3, 2009; 120(18): 1822 - 1836. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kelbaek, C. J. Terkelsen, S. Helqvist, J. F. Lassen, P. Clemmensen, L. Klovgaard, A. Kaltoft, T. Engstrom, H. E. Botker, K. Saunamaki, et al. Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trial. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 899 - 905. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A Gorog and I. Malik Clot removal in AMI--worth the hassle? Heart, March 1, 2008; 94(3): 258 - 259. [Full Text] [PDF]
|
|
|
|
|
|
A. Angelini, M. Della Barbera, and G. Thiene Interventional procedures for atherothrombosis: pathology of retrieved material Heart, October 1, 2007; 93(10): 1301 - 1308. [Full Text] [PDF]
|
|
|
|
|
|
I. Kusama, K. Hibi, M. Kosuge, N. Nozawa, H. Ozaki, H. Yano, S. Sumita, K. Tsukahara, J. Okuda, T. Ebina, et al. Impact of Plaque Rupture on Infarct Size in ST-Segment Elevation Anterior Acute Myocardial Infarction J. Am. Coll. Cardiol., September 25, 2007; 50(13): 1230 - 1237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kaltoft, M. Bottcher, S. S. Nielsen, H.-H. T. Hansen, C. Terkelsen, M. Maeng, J. Kristensen, L. Thuesen, L. R. Krusell, S. D. Kristensen, et al. Routine Thrombectomy in Percutaneous Coronary Intervention for Acute ST-Segment-Elevation Myocardial Infarction: A Randomized, Controlled Trial Circulation, July 4, 2006; 114(1): 40 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Limbruno and R. De Caterina EMERALD, AIMI, and PROMISE: is there still a potential for embolic protection in primary PCI? Eur. Heart J., May 2, 2006; 27(10): 1139 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Gorog, R. A. Foale, and I. Malik Distal Myocardial Protection During Percutaneous Coronary Intervention: When and Where? J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1434 - 1445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ferenc and F.-J. Neumann Efficacy of primary PCI: the microvessel perspective Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I4 - I9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Dudek, W. Mielecki, A. Dziewierz, J. Legutko, and J. S. Dubiel The role of thrombectomy and embolic protection devices Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I15 - I20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gick, N. Jander, H.-P. Bestehorn, R.-P. Kienzle, M. Ferenc, K. Werner, T. Comberg, K. Peitz, D. Zohlnhofer, V. Bassignana, et al. Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation Circulation, September 6, 2005; 112(10): 1462 - 1469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Mizote, Y. Ueda, T. Ohtani, M. Shimizu, Y. Takeda, T. Oka, M. Tsujimoto, A. Hirayama, M. Hori, and K. Kodama Distal Protection Improved Reperfusion and Reduced Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Who Had Angioscopically Defined Ruptured Plaque Circulation, August 16, 2005; 112(7): 1001 - 1007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S R Dixon Infarct angioplasty: beyond stents and glycoprotein IIb/IIIa inhibitors Heart, June 1, 2005; 91(suppl_3): iii2 - iii6. [Full Text] [PDF]
|
|
|
|
|
|
G. De Luca, A. W.J. van 't Hof, J. P. Ottervanger, J. C.A. Hoorntje, A.T. M. Gosselink, J.-H. E. Dambrink, M.-J. de Boer, and H. Suryapranata Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty Eur. Heart J., April 1, 2005; 26(7): 662 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W. Stone, J. Webb, D. A. Cox, B. R. Brodie, M. Qureshi, A. Kalynych, M. Turco, H. P. Schultheiss, D. Dulas, B. D. Rutherford, et al. Distal Microcirculatory Protection During Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Trial JAMA, March 2, 2005; 293(9): 1063 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schomig and A. Kastrati Distal Embolic Protection in Patients With Acute Myocardial Infarction: Attractive Concept But No Evidence of Benefit JAMA, March 2, 2005; 293(9): 1116 - 1118. [Full Text] [PDF]
|
|
|
|
|
|
C. O. Costantini, G. W. Stone, R. Mehran, E. Aymong, C. L. Grines, D. A. Cox, T. Stuckey, M. Turco, B. J. Gersh, J. E. Tcheng, et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction J. Am. Coll. Cardiol., July 21, 2004; 44(2): 305 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. W. O'Neill and S. R. Dixon The year in interventional cardiology J. Am. Coll. Cardiol., March 3, 2004; 43(5): 875 - 890. [Full Text] [PDF]
|
|
|
|
|
|
L Galiuto Optimal therapeutic strategies in the setting of post-infarct no reflow: the need for a pathogenetic classification Heart, February 1, 2004; 90(2): 123 - 125. [Full Text] [PDF]
|
|
|
|
 |
|
 Can Distal Protection Improve Primary Angioplasty Outcome? Journal Watch Cardiology, October 3, 2003; 2003(1003): 2 - 2. [Full Text]
|
|