Predictors and time-related impact of distal embolization during primary angioplasty.
OBJECTIVE
We sought to identify predictors of distal embolization (DE) occurring during primary percutaneous coronary intervention (p-PCI) as well as to assess its impact on both myocardial reperfusion and necrosis, according to time-to-treatment.


RESULTS
Clinical and angiographic characteristics were prospectively assessed in 400 consecutive patients who underwent p-PCI, in order to identify predictors of DE. The impact of DE on Thrombolysis in Myocardial Infarction (TIMI) flow, myocardial blush, and troponin I (TnI) was assessed according to symptom onset-to-balloon time. DE occurred in 64 (16%) patients and did not change with time-to-treatment (P = 0.87). The occlusion pattern of infarct-related artery (IRA), treatment of right coronary artery, higher TIMI thrombus score, longer lesion, and large IRA diameter were predictors of DE. The rate of TIMI 0/1 and myocardial blush 0/1 was higher in patients exhibiting DE when time-to-treatment was < or =6 h (P < 0.0001), while TnI was higher in patients with DE when time-to-treatment was <3 h.


CONCLUSIONS
DE during p-PCI occurs more often in the presence of high thrombus burden lesion. It reduces the effectiveness of myocardial reperfusion within 6 h and enhances myocardial damage within 3 h after symptom onset. Afterwards, it does not affect myocardial reperfusion or the extent of myocardial damage.
Napodano
Massimo
M
Cardiac Catheterization Laboratories and Interventional Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 2 via Giustiniani, 35100 Padova, Italy. massimo.napodano@gmail.com
Ramondo
Angelo
A
Tarantini
Giuseppe
G
Peluso
Diletta
D
Compagno
Silvia
S
Fraccaro
Chiara
C
Frigo
Anna Chiara
AC
Razzolini
Renato
R
Iliceto
Sabino
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D011446:Prospective Studies; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome