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Role of Embolic Protection in Percutaneous Coronary Intervention Without Saphenous Venous Graft Lesions in
Maisha Maliha1,2, Vikyath Satish1,2, Kuan Yu Chi1,2
1From the Department of Medicine, Jacobi Medical Center, Bronx, NY.
Insights
Embolic protection devices (EPDs) reduce distal embolization during percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (MI) without saphenous vein grafts (SVGs). However, EPDs did not significantly improve mortality or blood flow in this patient group.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Embolic protection devices (EPDs) capture debris during percutaneous coronary intervention (PCI).
- Their role in ST-segment-elevation myocardial infarction (MI) without saphenous vein grafts (SVGs) requires investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of EPDs in PCI procedures for ST-segment-elevation MI patients not involving SVGs.
- To assess the impact of EPDs on key clinical and procedural outcomes.
Main Methods:
- A meta-analysis of 3 randomized controlled trials (RCTs) was performed.
- Searched MEDLINE, Web of Science, and Embase databases up to April 10, 2024.
- Primary outcome: 30-day all-cause mortality. Secondary outcomes included major adverse events, flow attainment, ST-segment resolution, and distal embolization.
Main Results:
- EPDs significantly reduced angiographically detectable distal embolization (RR, 0.60; 95% CI, 0.36-0.99).
- No significant differences were observed in 30-day all-cause mortality (RR, 0.76; 95% CI, 0.31-1.86) or major adverse cardiovascular events (RR, 0.66; 95% CI, 0.34-1.27).
- Post-PCI flow and ST-segment resolution also showed no significant improvement.
Conclusions:
- EPDs effectively reduce distal embolization in PCI for ST-segment-elevation MI without SVGs.
- Current evidence does not support improved clinical outcomes like mortality or flow with EPD use in this setting.
- Further research is warranted to fully understand the benefits and indications for EPDs in these specific PCI procedures.
Introduction:
Embolic protection devices (EPDs) are catheter-based devices that can be used to capture atherosclerotic remnants released during percutaneous coronary intervention (PCI). We aim to study the efficacy and safety of EPDs in PCIs without saphenous vein grafts (SVGs) in ST-segment-elevation myocardial infarction (MI).
Methods:
Three electronic databases of MEDLINE, Web of Science, and Embase were searched from inception to April 10, 2024, to identify relevant randomized controlled trials that compared outcomes of patients subjected to EPD during PCI with a control group where EPDs were not utilized. The primary outcome was 30-day all-cause mortality. Secondary outcomes were major adverse cardiovascular and cerebrovascular events at 30 days, post-PCI thrombolysis in MI grade 3 flow attainment, ST-segment resolution at 90 minutes post-procedure, and postprocedure angiographically detectable signs of distal embolization. The effect estimates of outcomes were assessed using risk ratio (RR) with a 95% confidence interval (CI). Random-effects meta-analysis was conducted using the restricted maximum likelihood method, given that the interstudy variance was inevitable.
Results:
We included 3 randomized controlled trials enrolling 741 patients (age, 61.6 ± 12.15 years; 22% females) undergoing PCI without SVG lesions. As opposed to the control group, the use of EPD did not yield a significant effect on all-cause mortality [RR, 0.76 (95% CI, 0.31-1.86); I 2 = 0%], major adverse cardiovascular and cerebrovascular events [RR, 0.66 (95% CI, 0.34-1.27); I 2 = 0%], post-PCI thrombolysis in MI 3 flow [RR, 1.18 (95% CI, 0.86-1.62); I 2 = 77%], and ST-segment resolution at 90 minutes post-procedure [RR, 1.05 (95% CI, 0.90-1.22); I 2 = 0%]. However, EPD significantly decreased angiographically detectable signs of distal embolization [RR, 0.60 (95% CI, 0.36-0.99); I 2 = 0%].
Conclusions:
EPD significantly reduced angiographically detectable signs of distal embolization in PCI without SVG lesions in ST-segment-elevation MI though there were no clinical signs of improved flow or mortality. Further trials are necessary to thoroughly evaluate the potential benefits and requirements of EPD usage in such procedures.
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