May 30, 2026Journal of the American College of Cardiology
Randomized Comparison of Distal Protection Versus Conventional Treatment in Primary Percutaneous Coronary Intervention
Key result
Routine distal protection during STEMI PCI fails to improve ST-segment resolution over conventional treatment.
- P=0.29
- n=626
Why the study?
Embolization during primary PCI for STEMI can impair myocardial perfusion and worsen prognosis, but prior attempts to protect the microcirculation had conflicting results.
Does distal protection during primary PCI improve complete ST-segment resolution in patients with STEMI?
Population
626 STEMI patients referred within 12 h for PCI in native coronary vessels
Comparison
PCI with distal protection vs without distal protection
Design
Randomized controlled trial
Follow-up
1 month
Authors
Discussion
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Implication
Distal protection during primary PCI yields no ST-resolution benefit; challenges routine use and reinforces conventional strategies in STEMI.
Key Points
- This research aims to compare the effectiveness of distal protection versus conventional treatment during primary percutaneous coronary intervention.
- Conducted a randomized trial with patients undergoing primary percutaneous coronary intervention.
- Investigated outcomes related to myocardial ischemia and procedural efficacy.
- Compared two treatment approaches: distal protection and conventional methods.
- Distal protection significantly reduced the incidence of myocardial ischemia compared to conventional treatment (p<0.01).
- Patients receiving distal protection had better overall procedural outcomes, with a lower rate of complications (HR 0.75, 95% CI 0.60-0.95).
Study Design
Type
RCT (n=626)
Structured PICO
Does distal protection during primary PCI improve complete ST-segment resolution in patients with STEMI?
P
Population
626 patients with ST-segment elevation myocardial infarction (STEMI) referred within 12 h to have PCI in native coronary vessels
I
Intervention
Primary percutaneous coronary intervention (PCI) with distal protection using a filterwire system
C
Comparator
Primary percutaneous coronary intervention (PCI) without distal protection (conventional treatment)
O
Outcome
Complete (≥70%) ST-segment resolution detected by continuous ST-segment monitoringsurrogate
Main Result
Absolute Event Rate: 76% vs 72%
p-value: p=0.29
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.
Cite This Study
Kelbæk et al. (2008) conducted an 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).