title: Angiographic determinants of infarct size after successful percutaneous intervention for acute ST-elevation myocardial infarction: the impact of distal embolisation.
abstract: BACKGROUND
  We investigated the impact of distal embolisation and other angiographic determinants in patients after successful primary angioplasty for acute myocardial infarction.
  
  
  METHODS
  Angiographic data were assessed on the coronary angiogram carried out immediately after successful (TIMI 2 or 3) coronary angioplasty in 631 consecutive patients with acute myocardial infarction. Embolisation was defined as a distal filling defect with an abrupt 'cutoff' in ≥1 of the peripheral coronary artery branches of the infarct-related artery, distal to the site of angioplasty. Endpoints were left ventricular ejection fraction (LVEF) and enzymatic infarct size.
  
  
  RESULTS
  Left anterior descending artery related myocardial infarction, impaired myocardial blush and distal embolisation were independent determinants of infarct size. Distal embolisation was present in 102 patients (16%) and was associated with a larger enzymatic infarct size (LDH Q482250 vs. 1532, p=0.001) and a lower LVEF (41% vs. 44%, p=0.04). There was no difference in the frequency of distal embolisation between patients treated with or without stents.
  
  
  CONCLUSIONS
  In successful primary angioplasty, infarct-related artery, impaired myocardial blush and distal embolisation are independent determinants of infarct size. Distal embolisation can be visualised in 16% of the patients and is associated with a larger enzymatic infarct size and lower LVEF. Intracoronary stenting is not associated with an increased risk of distal embolisation during primary angioplasty.
authors.forename: J P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: J-H E
authors.initials: JH
authors.lastname: Dambrink
authors.forename: A W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: J C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: M-J
authors.initials: MJ
authors.lastname: de Boer
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
keywords: angiography; coronary stents; distal embolisation; myocardial blush grade; myocardial infarction; primary coronary angioplasty