title: Efficacy of an Embolic Protection Stent as a Function of Delay to Reperfusion in ST-Segment Elevation Myocardial Infarction (from the MASTER Trial).
abstract: The ability of stent implantation to improve indexes of reperfusion may depend on the time to reperfusion in acute ST-segment elevation myocardial infarction (STEMI) and may also vary with stent type. The purpose of this prespecified analysis from the randomized MGUARD for Acute ST Elevation Reperfusion trial was to evaluate the impact of delay to reperfusion on outcomes in patients with STEMI undergoing primary percutaneous coronary intervention with the MGuard embolic protection stent or standard metallic stents. A total of 431 patients were divided according to symptom-onset-to-balloon time (SBT) into 2 groups: SBT ≤3 hours (167 patients; 39%) and SBT >3 hours (264 patients; 61%). Complete ST-segment resolution (STR) after percutaneous coronary intervention was more often achieved in patients with shorter SBT (58.6% vs 47%, p = 0.02). At 1 year, the all-cause mortality rate was lower in patients with shorter SBT (0% vs 3.5%, p = 0.02). STR was achieved in 58% of MGuard patients and in 45% of the control stent patients (p = 0.008). STR was 57% in the MGuard group versus 38% in the control group (p = 0.002 for SBT >3 hours) and 60% versus 57% (p = 0.72), respectively, for SBT ≤3 hours (p for interaction = 0.11). In conclusion, longer delay to mechanical reperfusion remains an important factor negatively influencing outcomes in patients with STEMI. Use of the MGuard embolic protection stent compared with conventional metallic stents resulted in superior rates of complete STR, even in patients with longer delays to reperfusion.
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland. Electronic address: mcdudek@cyfronet.pl.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.affiliation: Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, Brooklyn, New York.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.affiliation: Institute Dante Pazzanese of Cardiology, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: Heart Center at the Isar, Munich, Germany.
authors.forename: Sigmund
authors.initials: S
authors.lastname: Silber
authors.affiliation: InspireMD, Tel Aviv, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Yaacoby
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, New York.
authors.forename: José M
authors.initials: JM
authors.lastname: Dizon
authors.affiliation: Institute Dante Pazzanese of Cardiology, São Paulo, Brazil.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.affiliation: Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian/Columbia University Medical Center, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Dressler
authors.affiliation: Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian/Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D057505:Embolic Protection Devices / Q000592:standards*; D004617:Embolism / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D011474:Prosthesis Design; D015424:Reperfusion; D015607:Stents; D016896:Treatment Outcome