Effect of distal protection device on the microvascular integrity in acute myocardial infarction during primary percutaneous coronary intervention.

Abstract

BACKGROUND: The use of a distal protection device during primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) may preserve the microvascular integrity of the myocardium.

METHODS AND RESULTS: A total of 58 consecutive patients with AMI, who had undergone primary PCI within 24 h after onset, were enrolled (30 patients with the PercuSurge GuardWire System, 28 without). The coronary flow velocity reserve was not different between the 2 groups. In patients with a distal protection device, the post-PCI Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMP) were more favorable (TMP 0/1: 13.3%, TMP 2: 23.3%, TMP 3: 63.4% vs TMP 0/1: 35.7%, TMP 2: 35.7%, TMP 3: 28.6%, p=0.023). These patients also exhibited lower basal and hyperemic microvascular resistance index levels (4.33+/-2.22 vs 5.55+/-2.36 mmHg . cm(-1) . s, p=0.047; 2.39+/-1.40 vs 3.14+/-1.36 mmHg . cm(-1) . s, p=0.045, respectively), and longer basal diastolic deceleration time (679+/-273 vs 519+/-289 ms, p=0.035) after PCI.

CONCLUSION: Distal protection with the PercuSurge GuardWire system may effectively preserve the microvascular integrity of the myocardium during primary PCI in AMI patients.