Effects of a distal protection device during primary stenting in patients with acute anterior myocardial infarction.
BACKGROUND
The angiographic no-reflow phenomenon is an adverse prognostic factor in patients with acute myocardial infarction (AMI). The aim of the present study was to evaluate the effects of an occlusive balloon type distal protection device (PercuSurge GuardWire: GW) during primary stenting in patients with anterior AMI.


RESULTS
The GW group included 42 patients treated by primary stenting with GW protection and the control group included 30 patients treated by primary stenting after thrombectomy without distal protection. Left ventricular (LV) function was measured and compared by left ventriculography obtained soon after percutaneous coronary intervention (PCI) and 3 weeks after onset. The corrected TIMI frame count values were lower in the GW group than in the control group (27.5+/-2.3 vs 35.1 +/-2.5, p=0.030). The number of patients with myocardial blush grade 3 after PCI was higher in the GW group than in the control group (45.7 vs 20.0%, p=0.029). Peak concentration of creatine kinase myocardial fraction was lower in the GW group than in the control group (326.6+/-41.5 vs 454.9+/-46.2 mg/dl, p=0.043). GW patients showed greater improvement at 3 weeks after PCI in terms of LV ejection fraction (+4.6+/-1.2 vs -1.1+/-1.5, p=0.004), LV end-systolic volume index (+0.5+/-2.4 vs +9.0+/-2.7, p=0.023), and regional wall motion abnormalities (-2.03+/-0.14 vs -2.51+/-0.14, p=0.018).


CONCLUSIONS
Primary stenting with GW protection can restore epicardial coronary flow and myocardial perfusion, and also preserve LV function in anterior AMI.
Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Tomohiro
T
Nakamura
Norifumi
N
Kubo
Yuichi
Y
Seki
Nahoko
N
Ikeda
Takeshi
T
Ishida
Hiroshi
H
Funayama
Shigemasa
S
Hashimoto
Takanori
T
Yasu
Mikihisa
M
Fujii
Masanobu
M
Kawakami
Muneyasu
M
Saito
D001783:Blood Flow Velocity; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome