Routine use of distal protection during primary PCI for STEMI did not significantly improve complete ST-segment resolution compared to conventional treatment (76% vs. 72%, p=0.29).
RCT (n=626)
Does distal protection during primary PCI improve complete ST-segment resolution in patients with STEMI?
Routine use of distal protection by a filterwire system during primary PCI for STEMI does not improve microvascular perfusion, limit infarct size, or reduce the occurrence of MACCE.
Absolute Event Rate: 76% vs 72%
p-value: p=0.29
OBJECTIVES: The purpose of this study was to evaluate the use of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in native coronary vessels. BACKGROUND: Embolization of material from the infarct-related lesion during PCI may result in impaired myocardial perfusion and worsen the prognosis. Previous attempts to protect the microcirculation during primary PCI have had conflicting results. METHODS: We randomly assigned 626 patients with STEMI referred within 12 h to have PCI performed with (n = 312) or without (n = 314) distal protection. The primary end point was complete (>or=70%) ST-segment resolution detected by continuous ST-segment monitoring. Blood levels of troponin-T and creatine kinase-MB were monitored before and after the procedure, and echocardiographic determination of the left ventricular wall motion index (WMI) was performed before discharge. RESULTS: Patients were well matched in terms of demographic and angiographic baseline characteristics. There was no significant difference in the occurrence of the primary end point (76% vs. 72%, p = 0.29), no difference in maximum troponin-T (4.8 microg/l and 5.0 microg/l, p = 0.87) or maximum creatine kinase-MB (185 microg/l and 184 microg/l, p = 0.99), and no difference in median WMI (1.70 vs. 1.70, p = 0.35). The rate of major adverse cardiac and cerebral events (MACCE) 1 month after PCI was 5.4% with distal protection and 3.2% with conventional treatment (p = 0.17). CONCLUSIONS: The routine use of distal protection by a filterwire system during primary PCI does not seem to improve microvascular perfusion, limit infarct size, or reduce the occurrence of MACCE.
Kelbæk et al. (Sat,) conducted a rct in ST-segment elevation myocardial infarction (STEMI) (n=626). Distal protection during primary PCI vs. Conventional treatment (PCI without distal protection) was evaluated on Complete (≥70%) ST-segment resolution detected by continuous ST-segment monitoring (p=0.29). Routine use of distal protection during primary PCI for STEMI did not significantly improve complete ST-segment resolution compared to conventional treatment (76% vs. 72%, p=0.29).