The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study

Jacob Lønborg; Henning Kelbæk; Steffen Helqvist; Lene Holmvang; Erik Jørgensen; Kari Saunamäki; Lene Kløvgaard; Anne Kaltoft; Hans Erik Bøtker; Jens F Lassen; Leif Thuesen; Christian Juhl Terkelsen; Klaus Fuglsang Kofoed; Peter Clemmensen; Lars Køber; Thomas Engstrøm

doi:10.1177/2048872614543780

The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study

Jacob Lønborg, Henning Kelbæk, Steffen Helqvist, Lene Holmvang, Erik Jørgensen, Kari Saunamäki, Lene Kløvgaard, Anne Kaltoft, Hans Erik Bøtker, Jens F Lassen, Leif Thuesen, Christian Juhl Terkelsen, Klaus Fuglsang Kofoed, Peter Clemmensen, Lars Køber, Thomas Engstrøm

Department of Clinical Medicine

11 Citations (Scopus)

Abstract

OBJECTIVES: The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.

METHODS AND RESULTS: In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.

CONCLUSION: DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.

Original language	English
Journal	European Heart Journal
Volume	4
Issue number	2
Pages (from-to)	180-188
Number of pages	9
ISSN	0195-668X
DOIs	https://doi.org/10.1177/2048872614543780
Publication status	Published - 1 Apr 2015

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Lønborg, J., Kelbæk, H., Helqvist, S., Holmvang, L., Jørgensen, E., Saunamäki, K., Kløvgaard, L., Kaltoft, A., Bøtker, H. E., Lassen, J. F., Thuesen, L., Terkelsen, C. J., Kofoed, K. F., Clemmensen, P., Køber, L., & Engstrøm, T. (2015). The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study. European Heart Journal, 4(2), 180-188. https://doi.org/10.1177/2048872614543780

The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study. / Lønborg, Jacob; Kelbæk, Henning; Helqvist, Steffen et al.

In: European Heart Journal, Vol. 4, No. 2, 01.04.2015, p. 180-188.

Research output: Contribution to journal › Journal article › Research › peer-review

Lønborg, J, Kelbæk, H, Helqvist, S, Holmvang, L, Jørgensen, E, Saunamäki, K, Kløvgaard, L, Kaltoft, A, Bøtker, HE, Lassen, JF, Thuesen, L, Terkelsen, CJ, Kofoed, KF, Clemmensen, P, Køber, L & Engstrøm, T 2015, 'The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study', European Heart Journal, vol. 4, no. 2, pp. 180-188. https://doi.org/10.1177/2048872614543780

Lønborg J, Kelbæk H, Helqvist S, Holmvang L, Jørgensen E, Saunamäki K et al. The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study. European Heart Journal. 2015 Apr 1;4(2):180-188. doi: 10.1177/2048872614543780

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title = "The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study",

abstract = "OBJECTIVES: The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.METHODS AND RESULTS: In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.CONCLUSION: DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.",

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T1 - The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study

AU - Lønborg, Jacob

AU - Kelbæk, Henning

AU - Helqvist, Steffen

AU - Holmvang, Lene

AU - Jørgensen, Erik

AU - Saunamäki, Kari

AU - Kløvgaard, Lene

AU - Kaltoft, Anne

AU - Bøtker, Hans Erik

AU - Lassen, Jens F

AU - Thuesen, Leif

AU - Terkelsen, Christian Juhl

AU - Kofoed, Klaus Fuglsang

AU - Clemmensen, Peter

AU - Køber, Lars

AU - Engstrøm, Thomas

PY - 2015/4/1

Y1 - 2015/4/1

N2 - OBJECTIVES: The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.METHODS AND RESULTS: In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.CONCLUSION: DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.

AB - OBJECTIVES: The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.METHODS AND RESULTS: In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.CONCLUSION: DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.

U2 - 10.1177/2048872614543780

DO - 10.1177/2048872614543780

M3 - Journal article

C2 - 25013089

SN - 0195-668X

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EP - 188

JO - European Heart Journal

JF - European Heart Journal

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