Back to Search
Start Over
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
- Source :
- Lønborg, J, Kelbæk, H, Helqvist, S, Holmvang, L, Jørgensen, E, Saunamäki, K, Kløvgaard, L, Kaltoft, A, Bøtker, H E, Lassen, J F, Thuesen, L, Terkelsen, C J, Kofoed, K F, Clemmensen, P, Køber, L & Engstrøm, T 2014, ' 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 ', European Heart Journal: Acute Cardiovascular Care . https://doi.org/10.1177/2048872614543780
- Publication Year :
- 2014
- Publisher :
- Oxford University Press (OUP), 2014.
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Denmark
medicine.medical_treatment
Myocardial Infarction
Critical Care and Intensive Care Medicine
Risk Assessment
law.invention
Hospitals, University
Percutaneous Coronary Intervention
Randomized controlled trial
Recurrence
Risk Factors
law
Internal medicine
medicine
Humans
Prospective Studies
cardiovascular diseases
Myocardial infarction
Embolization
Angioplasty, Balloon, Coronary
Aged
business.industry
Reproducibility of Results
Percutaneous coronary intervention
General Medicine
Middle Aged
Prognosis
medicine.disease
Embolization, Therapeutic
Surgery
Treatment Outcome
surgical procedures, operative
Heart failure
Conventional PCI
Cohort
Cardiology
Female
Stents
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Mace
Follow-Up Studies
Subjects
Details
- ISSN :
- 20488734 and 20488726
- Volume :
- 4
- Database :
- OpenAIRE
- Journal :
- European Heart Journal: Acute Cardiovascular Care
- Accession number :
- edsair.doi.dedup.....10eb32befec6f00dd8916fabb4c058d5