The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention--results from a randomized study

Jacob Lønborg, Henning Kelbæk, Steffen Helqvist, Lene Holmvang, Erik Jørgensen, Kari Saunamäki, Lene Kløvgaard, Anne Kaltoft, Hans E.rik Bøtker, Jens F. Lassen, Leif Thuesen, Christian J.uhl Terkelsen, Klaus F.uglsang Kofoed, Peter Clemmensen, Lars Køber, Thomas Engstrøm

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstrakt

OBJECTIVES: The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.

METHODS AND RESULTS: In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.

CONCLUSION: DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.

OriginalsprogEngelsk
Sider (fra-til)180-188
Antal sider9
TidsskriftEuropean heart journal. Acute cardiovascular care
Vol/bind4
Udgave nummer2
DOI
StatusUdgivet - 1 apr. 2015
Udgivet eksterntJa

Fingeraftryk Udforsk hvilke forskningsemner 'The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention--results from a randomized study' indeholder.

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