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Infarct size and left ventricular function in the PRoximal Embolic Protection in Acute myocardial infarction and
J D Haeck1, W J Kuijt, K T Koch
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.d.haeck@amc.uva.nl
Insights
Adding embolic protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) did not reduce final infarct size or improve heart function. Outcomes were similar between STEMI patients receiving PCI with embolic protection and those receiving PCI alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI).
- Proximal embolic protection devices aim to improve microvascular flow post-PCI, potentially leading to better patient outcomes.
- The PREPARE trial investigated the efficacy of combined proximal embolic protection and thrombus aspiration during primary PCI in STEMI.
Purpose of the Study:
- To evaluate if combined proximal embolic protection and thrombus aspiration during primary PCI reduces final infarct size.
- To assess if this combined approach improves left ventricular function in STEMI patients.
- To compare cardiovascular magnetic resonance (CMR) outcomes between STEMI patients treated with and without embolic protection.
Main Methods:
- Ancillary cardiovascular magnetic resonance (CMR) study of 206 STEMI patients from the PREPARE trial.
- CMR imaging was performed 4 to 6 months after the primary PCI procedure.
- Key metrics assessed included final infarct size, left ventricular ejection fraction, and systolic wall thickening.
Main Results:
- No significant difference in final infarct size between the embolic protection group (6.1 g/m²) and the control group (6.3 g/m²).
- Left ventricular ejection fraction remained similar, with no significant difference observed between groups (50% vs. 50%).
- Systolic wall thickening and the extent of transmural segments also showed no significant differences; major adverse cardiac and cerebral events were comparable at 6 months.
Conclusions:
- Combined proximal embolic protection and thrombus aspiration during primary PCI in STEMI does not significantly reduce final infarct size.
- This approach did not lead to significant improvements in left ventricular function at follow-up CMR.
- The incidence of major adverse cardiac and cerebral events was similar in both treatment groups, suggesting no added benefit from embolic protection in this context.
Objectives:
The aim of the study was to evaluate whether primary percutaneous coronary intervention (PCI) with combined proximal embolic protection and thrombus aspiration results in smaller final infarct size and improved left ventricular function assessed by cardiovascular magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients compared with primary PCI alone. Background Primary PCI with the Proxis system improves immediate microvascular flow post-procedure as measured by ST-segment resolution, which could result in better outcomes.
Methods:
The ancillary CMR study included 206 STEMI patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation (PREPARE) trial. CMR imaging was assessed between 4 and 6 months after the index procedure.
Results:
There were no significant differences in final infarct size (6.1 g/m(2) vs 6.3 g/m(2), p = 0.78) and left ventricular ejection fraction (50% vs 50%, p = 0.46) between both groups. Also, systolic wall thickening in the infarct area (44% vs 45%, p = 0.93) or the extent of transmural segments (8.3% of segments vs 8.3% of segments, p = 0.60) showed no significant differences. The incidence of major adverse cardiac and cerebral events at 6 months was similar in the Proxis and control group (8% vs 10%, respectively, p = 0.43). Conclusions Primary PCI with combined proximal embolic protection and thrombus aspiration in STEMI patients did not result in significant differences in final infarct size or left ventricular function at follow-up CMR. In addition, there was no difference in the incidence of major adverse cardiac and cerebral events at 6 months.
Trial Registration:
number ISRCTN71104460.
