title: The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention--results from a randomized study.
abstract: OBJECTIVE
  The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.
  
  
  RESULTS
  In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.
  
  
  CONCLUSIONS
  DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark jacoblonborg@gmail.com.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lønborg
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Kløvgaard
authors.affiliation: Department of Cardiology, Skejby, University of Aarhus, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.affiliation: Department of Cardiology, Skejby, University of Aarhus, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology, Skejby, University of Aarhus, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: Department of Cardiology, Skejby, University of Aarhus, Denmark.
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.affiliation: Department of Cardiology, Skejby, University of Aarhus, Denmark.
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003718:Denmark; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: ST-segment elevation myocardial infarction; distal embolization; distal protection; long term outcome; percutaneous coronary intervention