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Dislodgement of atheromatous (an abnormal fatty deposit in an artery) and thrombotic (blood clot) material ("debris") during percutaneous coronary intervention (PCI) following a heart attack is common. This debris may travel to more distal smaller vessels (beyond the site of arterial blockage) and may result in microcirculatory dysfunction. Prevention of this "distal embolization" may improve reperfusion success, reduce the damage caused by a blocked artery, and enhance event-free survival.

A procedure commonly used with PCI involves use of a specialized guidewire and catheter device to collect liberated embolic debris in the artery. Pilot studies and small randomized trials have demonstrated that distal (situated beyond the point in the obstructed artery) protection of the microcirculation during primary PCI retrieves embolic debris in most patients and may result in greater rates of normal blood flow, improved left ventricular function, and enhanced event-free survival compared with controls.

Gregg W. Stone, M.D., of Columbia University Medical Center and Cardiovascular Research Foundation, New York, and colleagues performed a clinical trial to evaluate the usefulness of distal microcirculatory protection during mechanical reperfusion therapy in acute myocardial infarction (AMI). The randomized controlled trial was conducted at 38 academic and community-based institutions in 7 countries, enrolling 501 patients aged 18 years or older with ST-segment elevation myocardial infarction (STEMI) presenting within 6 hours of symptom onset and undergoing primary PCI or rescue intervention after failed thrombolysis.

The patients were randomized between May 20, 2002, and November 21, 2003 to receive PCI with a
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Contact: Craig LeMoult
212-305-0820
JAMA and Archives Journals
1-Mar-2005