AIM: Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may result in reduced myocardial perfusion, infarct extension and impaired prognosis. In a prospective randomized trial, we assessed the effect of routine filterwire distal protection on scintigraphic estimated infarct size. METHODS AND RESULTS: The effect of routine filterwire distal protection was evaluated in 344 patients with STEMI <12 hours undergoing primary PCI. Patients were randomized to distal protection with a filterwire or standard PCI. The primary endpoint was myocardial infarct size measured by Sestamibi SPECT after 30 days (%). Secondary endpoints included myocardial salvage, ST-segment resolution (STR), myocardial biomarker release and major adverse cardiac and cerebral events. Baseline characteristics including area at risk (estimated by Sestamibi SPECT) were similar. Final infarct size was not statistically different in the distal protection and the control groups (median [IQR], 6% [1-19] and 5% [1-14], P = .23). Also, secondary endpoints were similar in the two treatment groups. CONCLUSION: Distal protection with a filterwire performed as routine therapy in primary PCI for STEMI did not reduce myocardial infarct size. The study does not support routine use of distal protection in primary PCI.
RCT Entities:
AIM: Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may result in reduced myocardial perfusion, infarct extension and impaired prognosis. In a prospective randomized trial, we assessed the effect of routine filterwire distal protection on scintigraphic estimated infarct size. METHODS AND RESULTS: The effect of routine filterwire distal protection was evaluated in 344 patients with STEMI <12 hours undergoing primary PCI. Patients were randomized to distal protection with a filterwire or standard PCI. The primary endpoint was myocardial infarct size measured by Sestamibi SPECT after 30 days (%). Secondary endpoints included myocardial salvage, ST-segment resolution (STR), myocardial biomarker release and major adverse cardiac and cerebral events. Baseline characteristics including area at risk (estimated by Sestamibi SPECT) were similar. Final infarct size was not statistically different in the distal protection and the control groups (median [IQR], 6% [1-19] and 5% [1-14], P = .23). Also, secondary endpoints were similar in the two treatment groups. CONCLUSION: Distal protection with a filterwire performed as routine therapy in primary PCI for STEMI did not reduce myocardial infarct size. The study does not support routine use of distal protection in primary PCI.
Authors: Ugo Limbruno; Andrea Micheli; Marco De Carlo; Giovanni Amoroso; Roberta Rossini; Caterina Palagi; Vitantonio Di Bello; Anna Sonia Petronio; Gabriella Fontanini; Mario Mariani Journal: Circulation Date: 2003-06-30 Impact factor: 29.690
Authors: Gregg W Stone; Michael A Peterson; Alexandra J Lansky; George Dangas; Roxana Mehran; Martin B Leon Journal: J Am Coll Cardiol Date: 2002-02-20 Impact factor: 24.094
Authors: K F Van Train; J Areeda; E V Garcia; C D Cooke; J Maddahi; H Kiat; G Germano; G Silagan; R Folks; D S Berman Journal: J Nucl Med Date: 1993-09 Impact factor: 10.057
Authors: Gregg W Stone; John Webb; David A Cox; Bruce R Brodie; Mansoor Qureshi; Anna Kalynych; Mark Turco; Heinz P Schultheiss; Daniel Dulas; Barry D Rutherford; David Antoniucci; Mitchell W Krucoff; Raymond J Gibbons; Denise Jones; Alexandra J Lansky; Roxana Mehran Journal: JAMA Date: 2005-03-02 Impact factor: 56.272
Authors: Henning Kelbaek; Christian J Terkelsen; Steffen Helqvist; Jens F Lassen; Peter Clemmensen; Lene Kløvgaard; Anne Kaltoft; Thomas Engstrøm; Hans E Bøtker; Kari Saunamäki; Lars R Krusell; Erik Jørgensen; Hans-Henrik T Hansen; Evald H Christiansen; Jan Ravkilde; Lars Køber; Klaus F Kofoed; Leif Thuesen Journal: J Am Coll Cardiol Date: 2008-03-04 Impact factor: 24.094
Authors: Adam Ali Ghotbi; Andreas Kjaer; Lars Nepper-Christensen; Kiril Aleksov Ahtarovski; Jacob Thomsen Lønborg; Niels Vejlstrup; Kasper Kyhl; Thomas Emil Christensen; Thomas Engstrøm; Henning Kelbæk; Lene Holmvang; Lia E Bang; Rasmus Sejersten Ripa; Philip Hasbak Journal: J Nucl Cardiol Date: 2016-10-14 Impact factor: 5.952