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Distal protection during PCI improves outcomes in patient subgroups
23 June 2008
MedWire News: Patients with right coronary artery (RCA) lesions, large thrombus, or large infarct-related artery can benefit from distal protection during primary percutaneous coronary intervention (PCI), researchers report.
"An adjunctive use of a distal protection device should be particularly considered to prevent thromboembolic procedural complications such as distal embolization and no-reflow phenomenon in this population subset," the authors suggest in the International Journal of Cardiology.
Hisashi Umeda (Toyota memorial Hospital, Toyota, Japan) and colleagues explored which groups of patients benefit from a distal protection device during PCI.
They enrolled 201 patients with ST-segment elevation acute myocardial infarction (STEMI), of whom 103 were provided with a distal protection device during primary PCI and 98 had primary PCI alone.
Both groups had similar rates of thromboembolic complications, optimal reperfusion (myocardial blush grade ≥2 and ST-segment resolution ≥70%), and infarct size.
However, the use of distal protection in patients with RCA lesions, thrombus scores ≥4; or infarct-related arteries of ≥3.5 mm in diameter, was associated with higher rates of optimal reperfusion compared with primary PCI alone, at odds ratios of 2.45 (p=0.034), 2.64 (p=0.034), and 4.09 (p=0.047), respectively.
These patients receiving distal protection were also less likely than those undergoing PCI alone to have thromboembolic complications, at a reduced risk of 64% (p=0.012), 45% (p=0.035), and 54% (p=0.05), respectively.
Distal protection resulted in a smaller infarct size compared with PCI alone in patients with RCA lesions, at 8.0 versus 11.7 mm (p=0.028), in those with a large thrombus, at 13.1 versus 17.4 mm (p=0.026), and in those with a large infarct-related artery, at 15.5 versus 22.1 mm (p=0.042).
Umeda and co-workers conclude: "In patients with culprit lesions located on the RCA, large thrombus burden, or large infarct-related artery, the use of a distal protection device during primary PCI resulted in a higher rate of patients achieving optimal reperfusion and smaller infarct size, possibly due to a reduced risk of thrombotic procedural complications."
