Abstract 10197: Utility of Thrombectomy and Distal Protection for the Preservation of Microcirculation in Diabetic Patients with ST-elevation Myocardial Infarction
Introduction: In the patients with myocardial infarction, diabetes is the independent risk for worse clinical outcome. Diabetes is supposed to be related to the innate impaired myocardial microcirculation. Nevertheless, the contemporary pharmacological and interventional remedies have yet to show the effectiveness for the preservation of microcirculation after STEMI in diabetic patients. The purpose of this study was to evaluate the impact of thrombectomy and distal protection diabetes on the coronary flow and microcirculation after STEMI.
Methods: Out of 696 STEMI patients enrolled either in the two multicenter randomized trials (VAMPIRE trial: tested the efficacy of thrombectomy or ASPARAGUS trial: tested the efficacy of distal protection device), 360 patients who have complete sets of angiographic data (Ejection fraction [EF] evaluated by left ventriculography, myocardial blush grade [MBG], TIMI grade and corrected TIMI frame count [CTFC]) at baseline and 6-months follow-up were evaluated. Delta value was calculated by [follow up — baseline]. Clinical data were corrected at the hospital admission.
Result: Out of the examined coronary risk factors, only diabetes showed the significant impact on follow-up MBG and Delta EF. There was no impact of diabetes and other risk factors on the follow-up TIMI grade and CTFC. In the patients who had thrombectomy and/or distal protection, rate of follow-up MBG:3 was equivalent between diabetic and non-diabetic patients (44.3% versus 49.6%, p=0.54). However, in the patients who had neither the thrombectomy nor the distal protection, follow-up MBG:3 was infrequent in diabetic patients (25.5% versus 46.3%, p=0.015).
Conclusion: Diabetes is the independent risk of microvascular damage after STEMI, regardless of the coronary flow. Thrombectomy and distal protection have a potential to preserve the myocardial microcirculation after STEMI and ameliorate the clinical outcome in diabetic patients.
- Coronary artery disease
- Acute coronary syndromes
- Coronary microcirculation
- Interventional cardiology
- © 2010 by American Heart Association, Inc.