title: Scintigraphic evaluation of routine filterwire distal protection in percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a randomized controlled trial.
abstract: 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.
authors.affiliation: Department of Cardiology B, Aarhus University Hospital, Skejby, 8200, Aarhus N, Denmark. annekaltoft@stofanet.dk
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.forename: Søren Steen
authors.initials: SS
authors.lastname: Nielsen
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Morten
authors.initials: M
authors.lastname: Bøttcher
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Lars Romer
authors.initials: LR
authors.lastname: Krusell
authors.forename: Steen Dalby
authors.initials: SD
authors.lastname: Kristensen
authors.forename: Jan
authors.initials: J
authors.lastname: Ravkilde
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbaek
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Evald Høj
authors.initials: EH
authors.lastname: Christiansen
authors.forename: Michael
authors.initials: M
authors.lastname: Rehling
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
mesh_terms: 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