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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Left ventricular contractile function after distal protection in primary percutaneous coronary intervention: results
K F Kofoed1, H Kelbæk, L Thuesen
1Department of Cardiology and Cardiac Catheterization Laboratory, The Heart Centre, Rigshospitalet, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark. kkofoed@dadlnet.dk
Insights
Distal protection devices during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) significantly improved left ventricular (LV) function. This method showed no adverse effect on clinical outcomes within eight months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) can lead to increased infarct size.
- Evaluating the impact of distal protection devices during PCI on myocardial function is crucial.
Purpose of the Study:
- To assess the effect of distal protection during PCI for STEMI on myocardial function.
- To compare left ventricular (LV) contractile function and clinical outcomes between patients treated with and without distal protection.
Main Methods:
- Randomized trial of STEMI patients undergoing PCI within 12 hours.
- Comparison of groups with (N=312) and without (N=314) distal protection.
- Assessment of LV contractile function using echocardiography and wall motion index (WMI) at 8 months post-PCI.
Main Results:
- No significant difference in the composite endpoint of death, re-infarction, or stroke at 8 months (7.1% vs. 5.7%, p=0.17).
- Significant improvement in global LV WMI at 8 months in the distal protection group (4.1%, p < 0.01).
- Enhanced regional LV function in myocardium treated with distal protection (9-11% higher, p < 0.02).
Conclusions:
- Routine use of distal protection during primary PCI is linked to improved LV contractile function.
- Distal protection during PCI for STEMI demonstrates no detectable negative impact on intermediate-term clinical outcomes.
Background:
Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function.
Methods:
Patients with STEMI were randomly referred within 12 h for PCI with (N = 312) or without distal protection (N = 314). Left ventricular (LV) contractile function was assessed with echocardiography 8 months after PCI. Global LV myocardial wall motion index (WMI) was calculated as the average wall motion score of all myocardial segments. The occurrence of death, nonfatal re-infarction, and stroke 8 months after PCI were also recorded.
Results:
The occurrence of death, nonfatal re-infarction, and stroke 8 months after PCI was 7.1% after distal protection and 5.7% after conventional treatment (p = 0.17). WMI improved by 4.1% at 8 months in patients treated with distal protection compared to patients receiving conventional PCI (p < 0.01). In myocardium supplied by a culprit artery treated by distal protection regional LV function was 9-11% higher than myocardial regions treated conventionally ( p < 0.02).
Conclusions:
Routine use of distal protection during primary PCI is associated with a significant improvement in LV contractile function, with no detectable impact on intermediate term clinical outcome.
