title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology and Cardiac Catheterization Laboratory, The Heart Centre, Rigshospitalet, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark. kkofoed@dadlnet.dk
authors.forename: K F
authors.initials: KF
authors.lastname: Kofoed
authors.forename: H
authors.initials: H
authors.lastname: Kelbæk
authors.forename: L
authors.initials: L
authors.lastname: Thuesen
authors.forename: S H
authors.initials: SH
authors.lastname: Poulsen
authors.forename: C
authors.initials: C
authors.lastname: Hassager
authors.forename: N H
authors.initials: NH
authors.lastname: Andersen
authors.forename: S
authors.initials: S
authors.lastname: Helqvist
authors.forename: J F
authors.initials: JF
authors.lastname: Lassen
authors.forename: P
authors.initials: P
authors.lastname: Clemmensen
authors.forename: L
authors.initials: L
authors.lastname: Kløvgaard
authors.forename: A
authors.initials: A
authors.lastname: Kaltoft
authors.forename: T
authors.initials: T
authors.lastname: Engstrøm
authors.forename: L R
authors.initials: LR
authors.lastname: Krusell
authors.forename: C J
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: L
authors.initials: L
authors.lastname: Køber
mesh_terms: 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