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Scintigraphic evaluation of routine filterwire distal protection in percutaneous coronary intervention for acute
Anne Kaltoft1, Søren Steen Nielsen, Christian Juhl Terkelsen
1Department of Cardiology B, Aarhus University Hospital, Skejby, 8200, Aarhus N, Denmark. annekaltoft@stofanet.dk
Insights
Routine filterwire use during primary percutaneous coronary intervention for ST-elevation myocardial infarction did not reduce infarct size. This approach is not supported for routine use in STEMI patients undergoing primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) can lead to reduced myocardial perfusion, infarct extension, and worse prognosis.
- Distal protection devices aim to mitigate these complications by capturing embolic debris.
Purpose of the Study:
- To assess the effect of routine filterwire distal protection on scintigraphic estimated infarct size in patients with STEMI undergoing primary PCI.
Main Methods:
- A prospective randomized trial involving 344 patients with STEMI undergoing primary PCI within 12 hours.
- Patients were randomized to receive either distal protection with a filterwire or standard PCI.
- Myocardial infarct size was the primary endpoint, measured by Sestamibi SPECT after 30 days.
Main Results:
- No statistically significant difference in final infarct size was observed between the distal protection group (median 6%) and the control group (median 5%) (P = .23).
- Secondary endpoints, including myocardial salvage, ST-segment resolution, biomarker release, and major adverse cardiac and cerebral events, were also similar between the groups.
Conclusions:
- Routine use of filterwire distal protection during primary PCI for STEMI does not reduce myocardial infarct size.
- The study does not support the routine application of distal protection devices in primary PCI for STEMI.
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.
