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  • Infarct size and left ventricular function in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-segment Elevation (PREPARE) trial: ancillary cardiovascular magnetic resonance study

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Acute coronary syndromes
Infarct size and left ventricular function in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-segment Elevation (PREPARE) trial: ancillary cardiovascular magnetic resonance study
  1. J D Haeck1,
  2. W J Kuijt1,4,
  3. K T Koch1,
  4. L Bilodeau2,
  5. J P Henriques1,
  6. W J Rohling1,
  7. J Baan Jr1,
  8. M M Vis1,
  9. R Nijveldt3,
  10. N van Geloven1,
  11. M Groenink1,
  12. J J Piek1,
  13. J G Tijssen1,
  14. M W Krucoff4,
  15. R J De Winter1
  1. 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Cardiology, Institut de Cardiology de Montréal, Montréal, Quebec, Canada
  3. 3Department of Cardiology, Vrije University Medical Center, Amsterdam, The Netherlands
  4. 4Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr J D Haeck, Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; j.d.haeck{at}amc.uva.nl

Abstract

Objectives The aim of the study was to evaluate whether primary percutaneous coronary intervention (PCI) with combined proximal embolic protection and thrombus aspiration results in smaller final infarct size and improved left ventricular function assessed by cardiovascular magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients compared with primary PCI alone.

Background Primary PCI with the Proxis system improves immediate microvascular flow post-procedure as measured by ST-segment resolution, which could result in better outcomes.

Methods The ancillary CMR study included 206 STEMI patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation (PREPARE) trial. CMR imaging was assessed between 4 and 6 months after the index procedure.

Results There were no significant differences in final infarct size (6.1 g/m2 vs 6.3 g/m2, p = 0.78) and left ventricular ejection fraction (50% vs 50%, p = 0.46) between both groups. Also, systolic wall thickening in the infarct area (44% vs 45%, p = 0.93) or the extent of transmural segments (8.3% of segments vs 8.3% of segments, p = 0.60) showed no significant differences. The incidence of major adverse cardiac and cerebral events at 6 months was similar in the Proxis and control group (8% vs 10%, respectively, p = 0.43).

Conclusions Primary PCI with combined proximal embolic protection and thrombus aspiration in STEMI patients did not result in significant differences in final infarct size or left ventricular function at follow-up CMR. In addition, there was no difference in the incidence of major adverse cardiac and cerebral events at 6 months.

Trial registration number ISRCTN71104460.

https://doi.org/10.1136/hrt.2009.180448

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    Footnotes

    • Funding This study is supported by grants from St Jude Medical and from the University of Amsterdam.

    • Competing interests None.

    • Ethics approval The study protocol was approved by the institutional review board of the Academic Medical Center, University of Amsterdam.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.