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Predictors of angiographically visible distal embolization in STEMI

N V Yaméogo1, C Guenancia2,3, G Porot1

  • 1Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.

Herz
|June 22, 2018
PubMed

Insights

Angiographically visible distal embolization (AVDE) occurs in 17% of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention with thrombectomy. The right coronary artery and larger culprit lesions predict AVDE, even with successful thrombectomy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Distal embolization during primary percutaneous coronary intervention (p-PCI) for ST-segment elevation myocardial infarction (STEMI) is linked to poor outcomes.
  • Thrombectomy is employed to mitigate distal embolization and enhance myocardial reperfusion.

Purpose of the Study:

  • To identify angiographic predictors of angiographically visible distal embolization (AVDE) in STEMI patients undergoing p-PCI with thrombectomy.

Main Methods:

  • Prospective study of STEMI patients undergoing p-PCI with thrombectomy (October 2011-December 2014).
  • AVDE defined as distal filling defect distal to the angioplasty site.
  • Thrombectomy success assessed by thrombus removal and coronary flow improvement.

Main Results:

  • 59 out of 346 patients (17%) experienced AVDE.
  • Independent predictors for AVDE included infarct-related right coronary artery (OR: 2.48) and culprit lesion diameter >3 mm (OR: 1.90).
  • Thrombectomy success and Syntax score were not associated with AVDE.

Conclusions:

  • AVDE is a frequent complication (17%) of p-PCI with thrombectomy in STEMI.
  • Successful thrombectomy does not preclude the occurrence of AVDE.
Abstract

Keywords:
Acute myocardial infarctionAngiographyDistal embolizationST-segment elevation myocardial infarctionThrombectomy

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