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Distal protection device aggravated microvascular obstruction evaluated by cardiac MR after primary percutaneous

Chang-Hwan Yoon1, Woo-Young Chung, Jung-Won Suh

  • 1Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea.

International Journal of Cardiology
|May 29, 2012
PubMed

Insights

Distal protection and thrombus aspiration (DP-TA) did not improve outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This strategy potentially increased microvascular obstruction, suggesting DP-TA should not be used in STEMI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Imaging

Background:

  • Distal protection and thrombus aspiration (DP-TA) aims to prevent distal embolization during primary percutaneous intervention (PCI) for ST-elevation myocardial infarction (STEMI).
  • Previous randomized trials have not demonstrated improved microvascular circulation or reduced myocardial injury with DP-TA.
  • This prospective randomized trial investigated the mechanism behind the limited efficacy of DP-TA in STEMI patients.

Purpose of the Study:

  • To investigate the mechanism of the poor effect of distal protection and thrombus aspiration (DP-TA) in STEMI patients undergoing primary PCI.
  • To evaluate the impact of DP-TA on left ventricular remodeling and myocardial injury compared to conventional PCI (c-PCI).

Main Methods:

  • A prospective randomized trial involving 126 STEMI patients assigned to either DP-TA or c-PCI.
  • Primary endpoint: Left ventricular end-diastolic volume (LVEDV) measured by cardiac MRI at post-PCI and 6 months.
  • Secondary endpoints: Infarct ratio, area at risk (AAR) ratio, microvascular occlusion (MVO) ratio, and myocardial salvage index (MSI) assessed by cardiac MRI within 3 days post-PCI.

Main Results:

  • No significant difference in LV remodeling (LVEDV) at 6 months between DP-TA and c-PCI groups.
  • Infarct ratio, AAR ratio, and MSI were similar between the groups.
  • A significantly larger MVO ratio was observed in the DP-TA group compared to the c-PCI group (p=0.045).

Conclusions:

  • Distal protection and thrombus aspiration (DP-TA) was found to be potentially hazardous in primary PCI for STEMI.
  • DP-TA was associated with an increased microvascular obstruction (MVO).
  • The findings suggest that DP-TA should not be used in the management of STEMI.
Abstract

Keywords:
Coronary microvascular functionDistal protection deviceMagnetic resonance imagingPrimary PCISTEMI

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