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Eligibility for use of proximal or distal embolic protection devices during percutaneous intervention for acute
Stephen J Mattichak1, Simon R Dixon, Robert D Safian
1William Beaumont Hospital, Royal Oak, MI 48073, USA.
Insights
Embolic protection devices are suitable for 78% of patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction. Anatomical suitability varied between proximal and distal device types, influencing device selection.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Embolic protection devices (EPDs) are increasingly considered for acute myocardial infarction (AMI).
- However, their utilization in unselected patient populations undergoing percutaneous coronary intervention (PCI) remains unclear.
- Assessing anatomical eligibility is crucial for effective EPD deployment.
Purpose of the Study:
- To evaluate the potential eligibility for proximal or distal EPD use.
- To assess suitability during primary or rescue PCI in a consecutive, nonselected AMI population.
Main Methods:
- Retrospective analysis of angiograms from 259 consecutive ST-elevation myocardial infarction (STEMI) patients.
- Determination of anatomical suitability for proximal and distal EPDs.
- Correlation of eligibility with culprit lesion location.
Main Results:
- Overall, 202 (78%) patients were anatomically suitable for EPD use.
- 154 (59%) were eligible for proximal protection, 128 (49%) for distal protection, and 80 (31%) for both.
- Proximal EPD eligibility was associated with right coronary artery culprit lesions; distal EPD eligibility with left anterior descending artery lesions.
Conclusions:
- A significant majority of STEMI patients are anatomically eligible for EPDs during PCI.
- The choice between proximal and distal EPDs depends on the specific coronary anatomy and culprit lesion location.
- These findings support the broader consideration of EPDs in STEMI management.
Abstract:
Although there has been enthusiasm for using embolic protection devices in acute myocardial infarction, it is unclear how often these devices can be used in nonselected patients. The aim of this study was to evaluate potential eligibility for use of either proximal or distal embolic protection during primary or rescue percutaneous coronary intervention in a consecutive, nonselected population. We analyzed the angiograms of 259 consecutive patients with ST-segment elevation myocardial infarction to determine eligibility for use of either type of protection device. Overall, 202 (78%) patients had anatomy suitable for embolic protection, including 154 (59%) who were eligible for proximal protection, 128 (49%) who were eligible for distal protection, and 80 (31%) who were eligible for both devices. Patients eligible for proximal protection were more likely to have a right coronary culprit, whereas patients eligible for distal protection were more likely to have a lesion in the left anterior descending coronary artery.
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