title: Increased rate of stent thrombosis and target lesion revascularization after filter protection in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: 15-month follow-up of the DEDICATION (Drug Elution and Distal Protection in ST Elevation Myocardial Infarction) trial.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  The use of distal filter protection during primary PCI increases procedure complexity and may influence lesion treatment and stent implantation.
  
  
  METHODS
  The STEMI patients were assigned to distal protection (DP) (n = 312) or conventional treatment (CT) (n = 314). Clinical follow-up was performed after 1, 6, and 15 months, and angiographic follow-up after 8 months. All target lesion revascularizations (TLRs) were clinically driven. We report the pre-specified end points of stent thrombosis according to the criteria of the Academic Research Consortium, TLR, and reinfarction after 15 months.
  
  
  RESULTS
  The total number of stent thrombosis was 11 in the DP group and 4 in the CT group (p = 0.06). The rate of definite stent thrombosis was significantly increased in the DP group as compared with the CT group, with 9 cases versus 1 (p = 0.01). Clinically driven TLRs (31 patients vs. 18 patients, p = 0.05) and clinically driven target vessel revascularizations (37 patients vs. 22 patients, p = 0.04) were more frequent in the DP group.
  
  
  CONCLUSIONS
  In primary PCI for STEMI, the routine use of DP increased the incidence of stent thrombosis and clinically driven target lesion/vessel revascularization during 15 months of follow-up. (Drug Elution and Distal Protection in ST Elevation Myocardial Infarction Trial [DEDICATION]; NCT00192868).
authors.affiliation: Department of Cardiology B, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark. annekaltoft@stofanet.dk
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbaek
authors.forename: Lene
authors.initials: L
authors.lastname: Kløvgaard
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D003718:Denmark / Q000453:epidemiology; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012086:Reoperation; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors