Left ventricular contractile function after distal protection in primary percutaneous coronary intervention Results from the Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction trial

• Published in: International journal of cardiology 2011-02, Vol.146 (3), p.395-398
• Main Authors: KOFOED, K. F, KELBAEK, H, KALTOFT, A, ENGSTRØM, T, KRUSELL, L. R, TERKELSEN, C. J, KØBER, L, THUESEN, L, POULSEN, S. H, HASSAGER, C, ANDERSEN, N. H, HELQVIST, S, LASSEN, J. F, CLEMMENSEN, P, KLØVGAARD, L
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Coronary heart disease; Diseases of the cardiovascular system; Heart; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Myocardial Contraction; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Postoperative Complications - prevention & control; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Ultrasonic investigative techniques; Ventricular Function, Left
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2009.07.020

Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function. Patients with STEMI were randomly referred within 12 h for PCI with (N = 312) or without distal protection (N = 314). Left ventricular (LV) contractile function was assessed with echocardiography 8 months after PCI. Global LV myocardial wall motion index (WMI) was calculated as the average wall motion score of all myocardial segments. The occurrence of death, nonfatal re-infarction, and stroke 8 months after PCI were also recorded. The occurrence of death, nonfatal re-infarction, and stroke 8 months after PCI was 7.1% after distal protection and 5.7% after conventional treatment (p = 0.17). WMI improved by 4.1% at 8 months in patients treated with distal protection compared to patients receiving conventional PCI (p < 0.01). In myocardium supplied by a culprit artery treated by distal protection regional LV function was 9-11% higher than myocardial regions treated conventionally ( p < 0.02). Routine use of distal protection during primary PCI is associated with a significant improvement in LV contractile function, with no detectable impact on intermediate term clinical outcome.