Prevention of distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction. A review of current status.
Distal embolization is a relatively common complication in primary angioplasty and is associated with poor perfusion and higher mortality. The aim of this article is to critically review literature on pharmacological and mechanical therapies to prevent distal embolization in patients undergoing primary angioplasty. The literature was scanned by formal searches of electronic databases (MEDLINE, Pubmed) from January 1990 to March 2006 and scientific session abstracts (from January 1990 to March 2006) and oral presentation and/or expert slide presentations (from January 2002 to March 2006) (on TCT, AHA, ESC, ACC and EuroPCR websites). No language restrictions were enforced. Several pharmacological and mechanical therapies have been investigated to prevent distal embolization. Abciximab has been shown to reduce mortality, and its early administration may provide additional benefits in outcome due to improvement in preprocedural reperfusion. The results of randomized trials on adjunctive mechanical devices remain controversial. Even though they reduce distal embolization and improve myocardial perfusion, no benefits have been observed in terms of 30-day survival. Adjunctive abciximab has improved survival, and its early administration is to be recommended, particularly when transportation to a primary PCI center is needed. Pending the results of large randomized trials with long-term follow-up data, the routine use of adjunctive mechanical devices to prevent distal embolization cannot be recommended, though selective use of these devices might be considered when large thrombotic burden is present.
De Luca
Giuseppe
G
Division of Cardiology, 'Federico II' University, Naples, Italy. p.de_luca@libero.it
Suryapranata
Harry
H
Chiariello
Massimo
M
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D004621:Embolization, Therapeutic; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D015994:Incidence; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D009204:Myocardial Revascularization / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D018570:Risk Assessment; D016019:Survival Analysis; D017131:Thrombectomy / Q000295:instrumentation
D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab