BACKGROUND: We investigated the impact of distal embolisation and other angiographic determinants in patients after successful primary angioplasty for acute myocardial infarction. METHODS: Angiographic data were assessed on the coronary angiogram carried out immediately after successful (TIMI 2 or 3) coronary angioplasty in 631 consecutive patients with acute myocardial infarction. Embolisation was defined as a distal filling defect with an abrupt 'cutoff' in ≥1 of the peripheral coronary artery branches of the infarct-related artery, distal to the site of angioplasty. Endpoints were left ventricular ejection fraction (LVEF) and enzymatic infarct size. RESULTS: Left anterior descending artery related myocardial infarction, impaired myocardial blush and distal embolisation were independent determinants of infarct size. Distal embolisation was present in 102 patients (16%) and was associated with a larger enzymatic infarct size (LDH Q48 2250 vs. 1532, p=0.001) and a lower LVEF (41% vs. 44%, p=0.04). There was no difference in the frequency of distal embolisation between patients treated with or without stents. CONCLUSIONS: In successful primary angioplasty, infarct-related artery, impaired myocardial blush and distal embolisation are independent determinants of infarct size. Distal embolisation can be visualised in 16% of the patients and is associated with a larger enzymatic infarct size and lower LVEF. Intracoronary stenting is not associated with an increased risk of distal embolisation during primary angioplasty.
BACKGROUND: We investigated the impact of distal embolisation and other angiographic determinants in patients after successful primary angioplasty for acute myocardial infarction. METHODS: Angiographic data were assessed on the coronary angiogram carried out immediately after successful (TIMI 2 or 3) coronary angioplasty in 631 consecutive patients with acute myocardial infarction. Embolisation was defined as a distal filling defect with an abrupt 'cutoff' in ≥1 of the peripheral coronary artery branches of the infarct-related artery, distal to the site of angioplasty. Endpoints were left ventricular ejection fraction (LVEF) and enzymatic infarct size. RESULTS: Left anterior descending artery related myocardial infarction, impaired myocardial blush and distal embolisation were independent determinants of infarct size. Distal embolisation was present in 102 patients (16%) and was associated with a larger enzymatic infarct size (LDH Q48 2250 vs. 1532, p=0.001) and a lower LVEF (41% vs. 44%, p=0.04). There was no difference in the frequency of distal embolisation between patients treated with or without stents. CONCLUSIONS: In successful primary angioplasty, infarct-related artery, impaired myocardial blush and distal embolisation are independent determinants of infarct size. Distal embolisation can be visualised in 16% of the patients and is associated with a larger enzymatic infarct size and lower LVEF. Intracoronary stenting is not associated with an increased risk of distal embolisation during primary angioplasty.
Authors: G Belli; A Pezzano; A M De Biase; E Bonacina; P Silva; P Salvadè; G Piccalò; S Klugmann Journal: Catheter Cardiovasc Interv Date: 2000-07 Impact factor: 2.692
Authors: K Iwakura; H Ito; N Nishikawa; K Hiraoka; K Sugimoto; Y Higashino; T Masuyama; M Hori; K Fujii; T Minamino Journal: Am J Cardiol Date: 1999-08-15 Impact factor: 2.778
Authors: C L Grines; K F Browne; J Marco; D Rothbaum; G W Stone; J O'Keefe; P Overlie; B Donohue; N Chelliah; G C Timmis Journal: N Engl J Med Date: 1993-03-11 Impact factor: 91.245
Authors: M J de Boer; H Suryapranata; J C Hoorntje; S Reiffers; A L Liem; K Miedema; W T Hermens; M J van den Brand; F Zijlstra Journal: Circulation Date: 1994-08 Impact factor: 29.690
Authors: Ramón Rodrigo; Daniel Hasson; Juan C Prieto; Gastón Dussaillant; Cristóbal Ramos; Lucio León; Javier Gárate; Nicolás Valls; Juan G Gormaz Journal: Trials Date: 2014-05-29 Impact factor: 2.279