Background. Patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) with the Proxis system (St. Jude Medical, St. Paul, MN, USA) achieved significantly better microvascular flow as measured by ST-segment resolution. However, no differences were observed in left ventricular ejection fraction or infarct size as obtained by cardiovascular magnetic resonance imaging. The goal of the present study was to evaluate the effect of combined proximal embolic protection and thrombus aspiration on core-lab adjudicated angiographic outcomes.
Methods. In the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation (PREPARE) study, patients were randomised to primary PCI with the Proxis system (n=141) or primary PCI alone (n=143). An independent core laboratory re-evaluated all angiograms and adjudicated the angiographic outcomes and computerised quantitative blush evaluation (QuBE) value.
Results. There were no significant differences in Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade, or angiographic signs of distal embolisation among the two arms. QuBE values did not significantly differ between the Proxis-treated patients and control patients (15.1±5.4 vs. 15.8±5.5, respectively, p=0.34).
Conclusion. Primary PCI with combined proximal embolic protection and thrombus aspiration in STEMI patients more frequently resulted in complete immediate ST resolution compared with control patients. However, there were no significant differences in core laboratory adjudicated angiographic outcomes. (Neth Heart J 2010;18:531–6.)
Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten
‘t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998;97:2302–2306. PubMed
Vlaar PJ, Svilaas T, van der Horst, I, Diercks GF, Fokkema ML, de Smet BJ, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008;371:1915–1920. PubMedCrossRef
Haeck JD, Kuijt WJ, Koch KT, Bilodeau L, Henriques JP, Rohling WJ, et al. 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. Heart. 2010;96:190–195. PubMedCrossRef
Haeck JD, Koch KT, Bilodeau L, Van der Schaaf RJ, Henriques JP, Vis MM, et al. Randomized comparison of primary embolic protection and thrombus aspiration versus primary percutaneous coronary intervention alone in ST-segment elevation myocardial infarction: the PREPARE (PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation) study. JACC Cardiovasc Interv. 2009;2:934–943. PubMedCrossRef
Koch KT, Haeck JD, Van der Schaaf RJ, Alidjan FM, Henriques JP, Baan J, et al. Proximal embolic protection with aspiration in percutaneous coronary intervention using the Proxis device. Rev Cardiovasc Med. 2007;8:160–166. PubMed
Fokkema ML, Vlaar PJ, Vogelzang M, Gu YL, Kampinga MA, De Smet BJ, et al. Effect of High-Dose Intracoronary Adenosine Administration During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. Circ Cardiovasc Intervent. 2009;2:323–329. Ref Type: Abstract CrossRef
Gick M, Jander N, Bestehorn HP, Kienzle RP, Ferenc M, Werner K, et al. Randomized evaluation of the effects of filter-based distal protection on myocardial perfusion and infarct size after primary percutaneous catheter intervention in myocardial infarction with and without ST-segment elevation. Circulation. 2005;112:1462–1469. PubMedCrossRef
Sardella G, Mancone M, Bucciarelli-Ducci C, Agati L, Scardala R, Carbone I, et al. Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarct-related artery during primary percutaneous coronary intervention) prospective, randomized trial. J Am Coll Cardiol. 2009;53:309–315. PubMedCrossRef
- Proximal embolic protection in patients undergoing primary angioplasty for acute myocardial infarction (PREPARE): core lab adjudicated angiographic outcomes of a randomised controlled trial
Jr. J. Baan
R.J. de Winter
- Bohn Stafleu van Loghum
Neu im Fachgebiet Kardiologie
Mail Icon II