Is it possible to predict which patients need distal protection during primary angioplasty?

Hisashi Umeda, Mitsunori Iwase, Hideo Izawa, Toshiaki Katoh, Tomoko Gochi, Junji Toyama, Masaki Yokoya, Toyoaki Matsushita, Ryoji Ishiki, Haruo Inagaki, Toyoaki Murohara, Mitsuhiro Yokota

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Although the benefit of distal protection (DP) during primary percutaneous coronary intervention (PCI) remains questionable, there appears to be efficacy in some clinical situations. We sought to identify in patients with ST-segment elevation acute myocardial infarction (STEMI) which clinical and angiographic characteristics might indicate the patient who will benefit from the use of a DP device. Methods: A series of 103 consecutive patients with STEMI undergoing primary PCI using DP were compared with 98 consecutive patients treated by primary PCI alone. Results: The overall rates of thromboembolic complications and achievement of optimal reperfusion (myocardial blush grade ≥ 2 and ST-segment resolution ≥ 70%), and infarct size, were similar between the 2 groups. However, DP use was associated with higher rates of optimal reperfusion in patients with right coronary artery (RCA) lesions (OR 2.45; 95% CI, 1.07 to 5.59; P = 0.034), thrombus score ≥ 4 (OR 2.64; 95% CI, 1.07 to 6.50; P = 0.034) or infarct-related artery (IRA) of ≥ 3.5 mm in diameter (OR 4.09; 95% CI, 1.02 to 16.40; P = 0.047). In this population (RCA location, thrombus score ≥ 4, or IRA ≥ 3.5 mm), DP use reduced the risk of thromboembolic complications (64%, P = 0.012, 45%, P = 0.035 and 54%, P = 0.050, respectively), resulting in a smaller infarct size (8.0 ± 5.1 vs. 11.7 ± 7.5, P = 0.028, 13.1 ± 8.8 vs. 17.4 ± 10.0, P = 0.026 and 15.5 ± 10.8 vs. 22.1 ± 10.1, P = 0.042, respectively). Conclusions: The use of a DP during primary PCI may lead to a reduction of thromboembolic complications, subsequent higher rates of optimal reperfusion and reduced infarct size in patients with RCA culprit lesions, a large thrombus, or large IRA.

Original languageEnglish
Pages (from-to)179-185
Number of pages7
JournalInternational Journal of Cardiology
Volume127
Issue number2
DOIs
Publication statusPublished - 04-07-2008
Externally publishedYes

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Percutaneous Coronary Intervention
Angioplasty
Coronary Vessels
Thrombosis
Arteries
Patient Rights
Reperfusion
Myocardial Reperfusion
Myocardial Infarction
Equipment and Supplies
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Umeda, Hisashi ; Iwase, Mitsunori ; Izawa, Hideo ; Katoh, Toshiaki ; Gochi, Tomoko ; Toyama, Junji ; Yokoya, Masaki ; Matsushita, Toyoaki ; Ishiki, Ryoji ; Inagaki, Haruo ; Murohara, Toyoaki ; Yokota, Mitsuhiro. / Is it possible to predict which patients need distal protection during primary angioplasty?. In: International Journal of Cardiology. 2008 ; Vol. 127, No. 2. pp. 179-185.
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title = "Is it possible to predict which patients need distal protection during primary angioplasty?",
abstract = "Background: Although the benefit of distal protection (DP) during primary percutaneous coronary intervention (PCI) remains questionable, there appears to be efficacy in some clinical situations. We sought to identify in patients with ST-segment elevation acute myocardial infarction (STEMI) which clinical and angiographic characteristics might indicate the patient who will benefit from the use of a DP device. Methods: A series of 103 consecutive patients with STEMI undergoing primary PCI using DP were compared with 98 consecutive patients treated by primary PCI alone. Results: The overall rates of thromboembolic complications and achievement of optimal reperfusion (myocardial blush grade ≥ 2 and ST-segment resolution ≥ 70{\%}), and infarct size, were similar between the 2 groups. However, DP use was associated with higher rates of optimal reperfusion in patients with right coronary artery (RCA) lesions (OR 2.45; 95{\%} CI, 1.07 to 5.59; P = 0.034), thrombus score ≥ 4 (OR 2.64; 95{\%} CI, 1.07 to 6.50; P = 0.034) or infarct-related artery (IRA) of ≥ 3.5 mm in diameter (OR 4.09; 95{\%} CI, 1.02 to 16.40; P = 0.047). In this population (RCA location, thrombus score ≥ 4, or IRA ≥ 3.5 mm), DP use reduced the risk of thromboembolic complications (64{\%}, P = 0.012, 45{\%}, P = 0.035 and 54{\%}, P = 0.050, respectively), resulting in a smaller infarct size (8.0 ± 5.1 vs. 11.7 ± 7.5, P = 0.028, 13.1 ± 8.8 vs. 17.4 ± 10.0, P = 0.026 and 15.5 ± 10.8 vs. 22.1 ± 10.1, P = 0.042, respectively). Conclusions: The use of a DP during primary PCI may lead to a reduction of thromboembolic complications, subsequent higher rates of optimal reperfusion and reduced infarct size in patients with RCA culprit lesions, a large thrombus, or large IRA.",
author = "Hisashi Umeda and Mitsunori Iwase and Hideo Izawa and Toshiaki Katoh and Tomoko Gochi and Junji Toyama and Masaki Yokoya and Toyoaki Matsushita and Ryoji Ishiki and Haruo Inagaki and Toyoaki Murohara and Mitsuhiro Yokota",
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Umeda, H, Iwase, M, Izawa, H, Katoh, T, Gochi, T, Toyama, J, Yokoya, M, Matsushita, T, Ishiki, R, Inagaki, H, Murohara, T & Yokota, M 2008, 'Is it possible to predict which patients need distal protection during primary angioplasty?', International Journal of Cardiology, vol. 127, no. 2, pp. 179-185. https://doi.org/10.1016/j.ijcard.2007.04.076

Is it possible to predict which patients need distal protection during primary angioplasty? / Umeda, Hisashi; Iwase, Mitsunori; Izawa, Hideo; Katoh, Toshiaki; Gochi, Tomoko; Toyama, Junji; Yokoya, Masaki; Matsushita, Toyoaki; Ishiki, Ryoji; Inagaki, Haruo; Murohara, Toyoaki; Yokota, Mitsuhiro.

In: International Journal of Cardiology, Vol. 127, No. 2, 04.07.2008, p. 179-185.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is it possible to predict which patients need distal protection during primary angioplasty?

AU - Umeda, Hisashi

AU - Iwase, Mitsunori

AU - Izawa, Hideo

AU - Katoh, Toshiaki

AU - Gochi, Tomoko

AU - Toyama, Junji

AU - Yokoya, Masaki

AU - Matsushita, Toyoaki

AU - Ishiki, Ryoji

AU - Inagaki, Haruo

AU - Murohara, Toyoaki

AU - Yokota, Mitsuhiro

PY - 2008/7/4

Y1 - 2008/7/4

N2 - Background: Although the benefit of distal protection (DP) during primary percutaneous coronary intervention (PCI) remains questionable, there appears to be efficacy in some clinical situations. We sought to identify in patients with ST-segment elevation acute myocardial infarction (STEMI) which clinical and angiographic characteristics might indicate the patient who will benefit from the use of a DP device. Methods: A series of 103 consecutive patients with STEMI undergoing primary PCI using DP were compared with 98 consecutive patients treated by primary PCI alone. Results: The overall rates of thromboembolic complications and achievement of optimal reperfusion (myocardial blush grade ≥ 2 and ST-segment resolution ≥ 70%), and infarct size, were similar between the 2 groups. However, DP use was associated with higher rates of optimal reperfusion in patients with right coronary artery (RCA) lesions (OR 2.45; 95% CI, 1.07 to 5.59; P = 0.034), thrombus score ≥ 4 (OR 2.64; 95% CI, 1.07 to 6.50; P = 0.034) or infarct-related artery (IRA) of ≥ 3.5 mm in diameter (OR 4.09; 95% CI, 1.02 to 16.40; P = 0.047). In this population (RCA location, thrombus score ≥ 4, or IRA ≥ 3.5 mm), DP use reduced the risk of thromboembolic complications (64%, P = 0.012, 45%, P = 0.035 and 54%, P = 0.050, respectively), resulting in a smaller infarct size (8.0 ± 5.1 vs. 11.7 ± 7.5, P = 0.028, 13.1 ± 8.8 vs. 17.4 ± 10.0, P = 0.026 and 15.5 ± 10.8 vs. 22.1 ± 10.1, P = 0.042, respectively). Conclusions: The use of a DP during primary PCI may lead to a reduction of thromboembolic complications, subsequent higher rates of optimal reperfusion and reduced infarct size in patients with RCA culprit lesions, a large thrombus, or large IRA.

AB - Background: Although the benefit of distal protection (DP) during primary percutaneous coronary intervention (PCI) remains questionable, there appears to be efficacy in some clinical situations. We sought to identify in patients with ST-segment elevation acute myocardial infarction (STEMI) which clinical and angiographic characteristics might indicate the patient who will benefit from the use of a DP device. Methods: A series of 103 consecutive patients with STEMI undergoing primary PCI using DP were compared with 98 consecutive patients treated by primary PCI alone. Results: The overall rates of thromboembolic complications and achievement of optimal reperfusion (myocardial blush grade ≥ 2 and ST-segment resolution ≥ 70%), and infarct size, were similar between the 2 groups. However, DP use was associated with higher rates of optimal reperfusion in patients with right coronary artery (RCA) lesions (OR 2.45; 95% CI, 1.07 to 5.59; P = 0.034), thrombus score ≥ 4 (OR 2.64; 95% CI, 1.07 to 6.50; P = 0.034) or infarct-related artery (IRA) of ≥ 3.5 mm in diameter (OR 4.09; 95% CI, 1.02 to 16.40; P = 0.047). In this population (RCA location, thrombus score ≥ 4, or IRA ≥ 3.5 mm), DP use reduced the risk of thromboembolic complications (64%, P = 0.012, 45%, P = 0.035 and 54%, P = 0.050, respectively), resulting in a smaller infarct size (8.0 ± 5.1 vs. 11.7 ± 7.5, P = 0.028, 13.1 ± 8.8 vs. 17.4 ± 10.0, P = 0.026 and 15.5 ± 10.8 vs. 22.1 ± 10.1, P = 0.042, respectively). Conclusions: The use of a DP during primary PCI may lead to a reduction of thromboembolic complications, subsequent higher rates of optimal reperfusion and reduced infarct size in patients with RCA culprit lesions, a large thrombus, or large IRA.

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