title: Distal protection devices in primary percutaneous coronary intervention of native coronary artery lesions: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The use of embolic protection devices to decrease major adverse cardiac events (MACEs) in patients with saphenous vein graft lesions is considered class I therapy by the recent practice guidelines. However, the benefits of adjunctive protection devices to prevent distal embolization in patients with native coronary artery lesions are still a matter of debate. Therefore, we performed the meta-analysis to determine whether the use of distal protection devices during revascularization can improve myocardial perfusion and reduce the occurrence of MACEs compared with primary percutaneous coronary intervention (PCI) alone.
  
  
  RESULTS
  Studies were identified in English-language articles by search of Medline and Embase database (inception to December 2011). A total of 15 prospective randomized controlled trials involving 2783 patients were included for analysis (1378 patients in the distal protection device group and 1405 cases in the control group). Overall, adjunctive embolic protection was associated with significantly improved postprocedural TIMI 3 (thrombolysis in myocardial infarction 3) flow (OR 1.71; 95% CI 1.13-2.57; P = 0.01) and MBG 3 (myocardial blush grade 3) (OR 1.50; 95% CI 1.09-2.07; P = 0.01), whereas the overall MACEs analysis demonstrated that a nonsignificant trend was observed toward better clinical outcomes associated with adjunctive protection devices at 1 month (OR 0.80; 95% CI 0.55-1.15; P = 0.23) and at 6 months (OR 0.80; 95% CI 0.55-1.17; P = 0.24). When stratified by MACEs, no statistical differences were found among mortality, reinfarction, and target vessel revascularization (TVR), respectively.
  
  
  CONCLUSIONS
  The meta-analysis indicated an improvement of myocardial perfusion in AMI patients treated with adjunctive protection devices. However, a nonsignificant trend was observed toward a lower risk of MACEs in the distal protection device group when compared with the control group.
authors.affiliation: Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.forename: Xue-Hong
authors.initials: XH
authors.lastname: Dong
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.forename: Hai-Ming
authors.initials: HM
authors.lastname: Shi
mesh_terms: D000279:Administration, Cutaneous; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D057505:Embolic Protection Devices / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D016896:Treatment Outcome