Left ventricular contractile function after distal protection in primary percutaneous coronary intervention: results from the Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction trial.
BACKGROUND
Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function.


METHODS
Patients with STEMI were randomly referred within 12 h for PCI with (N = 312) or without distal protection (N = 314). Left ventricular (LV) contractile function was assessed with echocardiography 8 months after PCI. Global LV myocardial wall motion index (WMI) was calculated as the average wall motion score of all myocardial segments. The occurrence of death, nonfatal re-infarction, and stroke 8 months after PCI were also recorded.


RESULTS
The occurrence of death, nonfatal re-infarction, and stroke 8 months after PCI was 7.1% after distal protection and 5.7% after conventional treatment (p = 0.17). WMI improved by 4.1% at 8 months in patients treated with distal protection compared to patients receiving conventional PCI (p < 0.01). In myocardium supplied by a culprit artery treated by distal protection regional LV function was 9-11% higher than myocardial regions treated conventionally ( p < 0.02).


CONCLUSIONS
Routine use of distal protection during primary PCI is associated with a significant improvement in LV contractile function, with no detectable impact on intermediate term clinical outcome.
Kofoed
K F
KF
Department of Cardiology and Cardiac Catheterization Laboratory, The Heart Centre, Rigshospitalet, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark. kkofoed@dadlnet.dk
Kelbæk
H
H
Thuesen
L
L
Poulsen
S H
SH
Hassager
C
C
Andersen
N H
NH
Helqvist
S
S
Lassen
J F
JF
Clemmensen
P
P
Kløvgaard
L
L
Kaltoft
A
A
Engstrøm
T
T
Krusell
L R
LR
Terkelsen
C J
CJ
Køber
L
L
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006801:Humans; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D011183:Postoperative Complications / Q000517:prevention & control; D016277:Ventricular Function, Left