title: Predictors and clinical significance of angiographically detected distal embolization after primary percutaneous coronary interventions.
abstract: OBJECTIVE
  The aim of this study was to investigate clinical, angiographic and procedural predictors of distal embolization (DE) on angiography after primary percutaneous coronary intervention (PCI). The impact of DE on outcome in the first 30 days was also assessed.
  
  
  METHODS
  Between January 2004 and April 2006, primary PCI was performed in 212 consecutive patients with acute myocardial infarction (AMI) of < or = 12-h duration.
  
  
  RESULTS
  Distal embolization was present in 27 patients (12.7%) and more often observed in female sex (27.5 vs. 10.4%, P=0.01), in patients with right coronary artery involvement (52 vs. 28%, P=0.02), prerevascularization thrombolysis in myocardial infarction flow < or = 1 (89 vs. 69%, P=0.03), in the presence of high thrombus burden (92.6 vs. 39.5%, P=0.0009), and a long target lesion in the infarct-related artery (>14.5 mm, 74 vs. 29%, P<0.0001). By multiple stepwise logistic regression analysis, only the presence of high thrombus burden before the PCI procedure [odds ratio (OR)=5.2, 95% confidence interval (CI)=1.09-24.97, P=0.03)] and target lesion length (>14.5 mm, OR=3.9, 95% CI=1.45-10.60, P=0.007) were found independent predictors of DE. Patients with DE had an increased risk of target vessel revascularization (26 vs. 5%, P=0.001) and short-term mortality (29.6 vs. 7.5%, P=0.002) when compared with patients without angiographic signs of embolization.
  
  
  CONCLUSIONS
  In patients who undergo primary PCI, high thrombus burden on angiography before PCI and/or a long target lesion in the infarct-related artery increase the risk of DE and subsequent short-term mortality.
authors: Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital, Kartal, Istanbul, Turkey. akinizgi@hotmail.com
authors: Akin
authors: A
authors: Izgi
authors: Cevat
authors: C
authors: Kirma
authors: Ali Cevat
authors: AC
authors: Tanalp
authors: Cihan
authors: C
authors: Dundar
authors: Vecih
authors: V
authors: Oduncu
authors: Soe Moe
authors: SM
authors: Aung
authors: Kenan
authors: K
authors: Sonmez
authors: Bulent
authors: B
authors: Mutlu
authors: Denyan
authors: D
authors: Mansuroglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology*; D003331:Coronary Vessels / Q000473:pathology; D004617:Embolism / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome