Scintigraphic evaluation of routine filterwire distal protection in percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a randomized controlled trial.
OBJECTIVE
Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may result in reduced myocardial perfusion, infarct extension and impaired prognosis. In a prospective randomized trial, we assessed the effect of routine filterwire distal protection on scintigraphic estimated infarct size.


RESULTS
The effect of routine filterwire distal protection was evaluated in 344 patients with STEMI <12 hours undergoing primary PCI. Patients were randomized to distal protection with a filterwire or standard PCI. The primary endpoint was myocardial infarct size measured by Sestamibi SPECT after 30 days (%). Secondary endpoints included myocardial salvage, ST-segment resolution (STR), myocardial biomarker release and major adverse cardiac and cerebral events. Baseline characteristics including area at risk (estimated by Sestamibi SPECT) were similar. Final infarct size was not statistically different in the distal protection and the control groups (median [IQR], 6% [1-19] and 5% [1-14], P = .23). Also, secondary endpoints were similar in the two treatment groups.


CONCLUSIONS
Distal protection with a filterwire performed as routine therapy in primary PCI for STEMI did not reduce myocardial infarct size. The study does not support routine use of distal protection in primary PCI.
Kaltoft
Anne
A
Department of Cardiology B, Aarhus University Hospital, Skejby, 8200, Aarhus N, Denmark. annekaltoft@stofanet.dk
Nielsen
Søren Steen
SS
Terkelsen
Christian Juhl
CJ
Bøttcher
Morten
M
Lassen
Jens Flensted
JF
Krusell
Lars Romer
LR
Kristensen
Steen Dalby
SD
Ravkilde
Jan
J
Kelbaek
Henning
H
Bøtker
Hans Erik
HE
Christiansen
Evald Høj
EH
Rehling
Michael
M
Thuesen
Leif
L
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D003131:Combined Modality Therapy / Q000401:mortality; D003718:Denmark / Q000453:epidemiology; D004621:Embolization, Therapeutic / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D011877:Radionuclide Imaging; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate