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
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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. / Lønborg, Jacob; Kelbæk, Henning; Helqvist, Steffen; Holmvang, Lene; Jørgensen, Erik; Saunamäki, Kari; Kløvgaard, Lene; Kaltoft, Anne; Bøtker, Hans Erik; Lassen, Jens F; Thuesen, Leif; Terkelsen, Christian Juhl; Kofoed, Klaus Fuglsang; Clemmensen, Peter; Køber, Lars; Engstrøm, Thomas.
in: EUR HEART J-ACUTE CA, Jahrgang 4, Nr. 2, 04.2015, S. 180-188.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - 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
AU - Lønborg, Jacob
AU - Kelbæk, Henning
AU - Helqvist, Steffen
AU - Holmvang, Lene
AU - Jørgensen, Erik
AU - Saunamäki, Kari
AU - Kløvgaard, Lene
AU - Kaltoft, Anne
AU - Bøtker, Hans Erik
AU - Lassen, Jens F
AU - Thuesen, Leif
AU - Terkelsen, Christian Juhl
AU - Kofoed, Klaus Fuglsang
AU - Clemmensen, Peter
AU - Køber, Lars
AU - Engstrøm, Thomas
N1 - © The European Society of Cardiology 2014.
PY - 2015/4
Y1 - 2015/4
N2 - 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.
AB - 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.
KW - Aged
KW - Angioplasty, Balloon, Coronary/methods
KW - Denmark
KW - Embolization, Therapeutic
KW - Female
KW - Follow-Up Studies
KW - Hospitals, University
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Percutaneous Coronary Intervention/adverse effects
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Prognosis
KW - Prospective Studies
KW - Recurrence
KW - Reproducibility of Results
KW - Risk Assessment
KW - Risk Factors
KW - Stents
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1177/2048872614543780
DO - 10.1177/2048872614543780
M3 - SCORING: Journal article
C2 - 25013089
VL - 4
SP - 180
EP - 188
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 2
ER -
