title: The distal protection during primary percutaneous coronary intervention alleviates the adverse effects of large thrombus burden on myocardial reperfusion.
abstract: BACKGROUND
  The presence of intracoronary large thrombus burden (LTB) in the infarct-related artery increases the risk of distal embolization and no-reflow during percutaneous coronary intervention (PCI). Evaluation of whether the distal protection (DP) during primary PCI reduces adverse effects of LTB on myocardial reperfusion and infarct size was investigated.
  
  
  RESULTS
  A consecutive series of 88 patients with acute myocardial infarction undergoing primary PCI using DP were compared with 81 consecutive patients treated by primary PCI alone. The DP use showed similar post-procedural myocardial blush grade (MBG)-3 and infarct size, but improved corrected thrombolysis in myocardial infarction frame count (cTFC) (29+/-11 vs 35+/-20, p=0.011) and the incidence of ST-segment resolution (80.7% vs 66.7%, p=0.038). In patients with LTB present, however, the DP use reduced occurrences of no-reflow (0% vs 11.8%, p=0.036) and distal embolization (4.8% vs 17.6%, p=0.129), resulting in higher occurrences of MBG-3 (61.9% vs 35.3%, p=0.021) and ST-segment resolution (78.6% vs 50.0%, p=0.009), lower cTFC values (30+/-8 vs 40+/-22, p=0.012) and smaller infarct size (12.2+/-11.2 vs 18.7+/-11.1, p=0.015).
  
  
  CONCLUSIONS
  With an improved myocardial reperfusion and smaller infarct size in patients with LTB, the DP during primary PCI might be a better strategy in this particular setting compared with conventional strategy.
authors.affiliation: Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan. humedamd@ybb.ne.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Umeda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Katoh
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Iwase
authors.forename: Hideo
authors.initials: H
authors.lastname: Izawa
authors.forename: Kohzo
authors.initials: K
authors.lastname: Nagata
authors.forename: Kosuke
authors.initials: K
authors.lastname: Watanabe
authors.forename: Taro
authors.initials: T
authors.lastname: Okada
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Tani
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Matsushita
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Murakami
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Okamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokota
mesh_terms: D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome