Distal Protection During Primary Angioplasty in Patients with Acute Myocardial Infarction

Overview

Background.
The aim of the study was to assess the safety, feasibility and efficacy of mechanical distal protection during primary angioplasty using FilterWire EZ^® (FW). 

Method and Results.
Thirty-one patients with acute myocardial infarction (AMI) were treated by primary angioplasty with distal protection using FW. The results were compared with a matched control group consisting of 33 patients with AMI treated by primary angioplasty alone. Successful FW positioning was obtained in 30 patients (97 %). In these patients a lower rate of distal embolisation (3 vs. 18%, p=0,04) was found and a more effective reperfusion was assessed by ST elevation’s resolution >50% immediately after the procedure (83 vs.61 %, p=0,05). A higher number of patients with corrected TIMI frame count <27 in FW group supported more effective reperfusion to but this difference did not reached statistical significance (87 vs. 73 %, p=0,09). There were no differences between groups regarding average peak CK and CK-MB. However, there is a trend to lower release in FW group (32,1±24,5 vs. 35,3±31,0, p= 0,33; 4,2±3 vs. 4,4±3,7, p=0,44). 

Conclusions.
The presented study confirmed that distal embolisation during primary angioplasty is a frequent phenomenon. In this setting, adjunctive use of the FW is feasible and save, and it may improve myocardial reperfusion by reducing the embolic events. 

Key words:
acute myocardial infarction, primary angioplasty, embolism, distal protection.