Distal embolization influences outcome in STEMI patients
MedWire News: Distal embolization is associated with impaired myocardial perfusion and survival in patients treated with primary angioplasty and glycoprotein (Gp) IIb-IIIa inhibitors for ST segment elevation myocardial infarction (STEMI), study findings indicate.
Primary angioplasty has been shown to improve survival as compared with thrombolysis, mainly due to a larger percentage of restoration of complete perfusion, explain Giuseppe De Luca (Eastern Piedmont University, Novara, Italy) and colleagues.
"However, epicardial recanalization does not guarantee optimal myocardial perfusion," say the researchers.
To investigate the impact of distal embolization on myocardial perfusion and survival, De Luca and team studied 1182 patients with STEMI undergoing primary angioplasty with Gp IIb-IIIa inhibitors.
The researchers report that distal embolization was observed in 132 (11.1%) patients between 30 days and 1 year after primary angioplasty.
Patients with distal embolization were significantly older than those without, with a larger prevalence of diabetes, previous MI, and advanced Killip class at presentation. They were more likely to have received abciximab, and had a lower prevalence of smoking than patients without distal embolization.
In addition, patients with distal embolization had a larger infarct size than those without and were more likely to have poor preprocedural recanalization and less likely to have postprocedural thrombolysis in myocardial infarction (TIMI) 3 flow, postprocedural myocardial blush grade (MBG) 2-3, and complete ST-segment resolution.
After adjustment for baseline confounding factors, distal embolization was associated with a 3.14-fold increased risk for MBG 2-3 and a 2.23-fold increased risk for death after 208 days of follow-up, compared with no distal embolization.
"Due to the relatively large incidence of distal embolization and impaired perfusion observed in the current study despite extensive use of Gp IIb-IIIa inhibitors, thrombectomy devices should be considered in order to prevent distal embolization, to improve myocardial perfusion and survival," conclude De Luca and co-authors in the Journal of Thrombosis and Thrombolysis.
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By Laura Dean