Distal protection device protects microvascular integrity during primary percutaneous intervention in acute myocardial infarction: A prospective, randomized, multicenter trial

Tahk, Seung Jea; Choi, Byoung‐Joo; Choi, So Yeon; Yoon, Myeong‐Ho; Gwon, Hyeon Cheol; Hong, Geu Ru; Kim, Young Jo; Hur, Seung‐Ho; Kim, Kwon Bae; Koo, Bon Kwon; Lee, Seung Hwan; Yoon, Junghan

doi:10.1016/j.ijcard.2007.03.124

Cited by 20 publications

(6 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the time interval from onset of symptoms to reperfusion is an important factor in rescuing ischemic myocardium in AMI. Compared with those in EMERALD study, our patients had a longer time interval, and accordingly higher risk myocardium might more probably benefit from DPDs [11,19].…”

Section: Efficacy Of Distal Protection Devicementioning

confidence: 67%

“…Recently, the Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by ThrombusAspiration in Primary and Rescue Angioplasty (REMEDIA) trial showed better angiographic and electrocardiographic myocardial perfusion rates in the myocardial protection arm compared with those achieved by standard PCI [7]. Along with the promising results with DPDs, some inconclusive and conflicting data in AMI interventions have been the subject of controversy [9][10][11]. The large randomized Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial showed that DPDs allowed effective retrieval of embolic debris in most patients with AMI undergoing emergent PCI.…”

Section: Efficacy Of Distal Protection Devicementioning

confidence: 99%

“…Early studies of DPDs in AMI patients reported improvements in myocardial perfusion and ST-segment resolution compared with conventional PCI techniques [2,3,[6][7][8]. Some subsequent studies yielded neutral results [9][10][11]. Whether myocardial function can be improved with DPDs compared with conventional PCI in patients with AMI is still under debate [3,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…There are limited echocardiographic data describing changes in cardiac function in DPDs studies, and no data describing changes in regional myocardial function. Only the left ventricular (LV) ejection fraction and the wall motion score index have been used to evaluate global LV systolic function in a few studies [9,11].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effects of distal protection on left ventricular function in acute anterior myocardial infarction: a Doppler echocardiographic study

Duan

Zhang

Liu

et al. 2009

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Whether distal protection devices (DPDs) during percutaneous coronary intervention (PCI) can improve myocardial function in patients with acute myocardial infarction (AMI) is still under debate. Using tissue Doppler imaging (TDI), we evaluate the global and regional left ventricular systolic and diastolic functions in patients with anterior AMI using DPDs compared with conventional PCI. Ninety-six patients with anterior AMI were randomly assigned to either PCI with DPDs (DPD, n = 46) or traditional PCI (control, n = 50) groups. At the 3- and 6-month follow-ups, the DPD group had a higher left ventricular ejection fraction than the control group (51.6 +/- 3.6 vs. 49.3 +/- 5.3% and 53.0 +/- 3.7 vs. 50.8 +/- 5.2%, respectively; both P < 0.05). Moreover, peak systolic (S (a)) and early diastolic (E (a)) mitral annular velocities obtained by TDI were significantly higher in the DPD group than in the control group (S (a): 7.57 +/- 0.53 vs. 7.12 +/- 0.62 cm/s and 7.71 +/- 0.63 vs. 7.32 +/- 0.59 cm/s; E (a): 7.23 +/- 0.78 vs. 6.89 +/- 0.86 cm/s and 7.49 +/- 0.69 vs. 7.04 +/- 0.85 cm/s, respectively; all P < 0.05). However, systolic and diastolic regional myocardial velocities significantly improved in the DPD group from the 1-month follow-up compared with those in the control group (all P < 0.05). Patients who received treatment with DPDs experienced enhanced improvement of cardiac function. Thus, anterior AMI patients can benefit from DPDs during PCI.

show abstract

Section: Efficacy Of Distal Protection Devicementioning

confidence: 67%

Section: Efficacy Of Distal Protection Devicementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of distal protection on left ventricular function in acute anterior myocardial infarction: a Doppler echocardiographic study

Duan

Zhang

Liu

et al. 2009

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

show abstract

“…Compared to standard PCI, 17 trials evaluated catheter aspiration devices [8-12,15-17,21-30] (n = 3355; 11 good, 3 fair and 3 poor quality trials), 5 trials evaluated mechanical thrombectomy devices [7,31-34] (n = 1374; 5 good quality), 9 trials evaluated distal balloon embolic protection devices [13,35-42] (n = 1479; 8 good and 1 fair quality), 5 trials evaluated distal filter embolic protection devices [43-47] (n = 962; 4 good and 1 fair quality), and trial evaluated proximal balloon embolic protection devices [14] (n = 284, good quality).…”

Section: Resultsmentioning

confidence: 99%

Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels

Sobieraj

White

Kluger

et al. 2011

BMC Cardiovasc Disord

View full text Add to dashboard Cite

BackgroundDuring percutaneous coronary intervention (PCI), dislodgement of atherothrombotic material from coronary lesions can result in distal embolization, and may lead to increased major adverse cardiovascular events (MACE) and mortality. We sought to systematically review the comparative effectiveness of adjunctive devices to remove thrombi or protect against distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI of native vessels.MethodsWe conducted a systematic literature search of Medline, the Cochrane Database, and Web of Science (January 1996-March 2011), http://www.clinicaltrials.gov, abstracts from major cardiology meetings, TCTMD, and CardioSource Plus. Two investigators independently screened citations and extracted data from randomized controlled trials (RCTs) that compared the use of adjunctive devices plus PCI to PCI alone, evaluated patients with STEMI, enrolled a population with 95% of target lesion(s) in native vessels, and reported data on at least one pre-specified outcome. Quality was graded as good, fair or poor and the strength of evidence was rated as high, moderate, low or insufficient. Disagreement was resolved through consensus.Results37 trials met inclusion criteria. At the maximal duration of follow-up, catheter aspiration devices plus PCI significantly decreased the risk of MACE by 27% compared to PCI alone. Catheter aspiration devices also significantly increased the achievement of ST-segment resolution by 49%, myocardial blush grade of 3 (MBG-3) by 39%, and thrombolysis in myocardial infarction (TIMI) 3 flow by 8%, while reducing the risk of distal embolization by 44%, no reflow by 48% and coronary dissection by 70% versus standard PCI alone. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment.Distal filter embolic protection devices significantly increased the risk of target revascularization by 39% although the use of mechanical thrombectomy or embolic protection devices did not significantly impact other final health outcomes. Distal balloon or any embolic protection device increased the achievement of MBG-3 by 61% and 20% and TIMI3 flow by 11% and 6% but did not significantly impact other intermediate outcomes versus control. Upon qualitative analysis, all device categories, with exception of catheter aspiration devices, appear to significantly prolong procedure time compared to PCI alone while none appear to significantly impact ejection fraction. Many of the final health outcome and adverse event evaluations were underpowered and the safety of devices overall is unclear due to insufficient amounts of data.ConclusionsIn patients with STEMI, for most devices, few RCTs evaluated final health outcomes over a long period of follow-up. Due to insufficient data, the safety of these devices is unclear.

show abstract

Percutaneous Coronary Intervention

Kumbhani¹,

Bhatt²

2012

Cardiovascular Clinical Trials

View full text Add to dashboard Cite

Distal protection device protects microvascular integrity during primary percutaneous intervention in acute myocardial infarction: A prospective, randomized, multicenter trial

Cited by 20 publications

References 36 publications

Effects of distal protection on left ventricular function in acute anterior myocardial infarction: a Doppler echocardiographic study

Effects of distal protection on left ventricular function in acute anterior myocardial infarction: a Doppler echocardiographic study

Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels

Percutaneous Coronary Intervention

Contact Info

Product

Resources

About