Distal Microcirculatory Protection During Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial InfarctionA Randomized Controlled Trial

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Abstract
Myocardial salvage is frequently suboptimal after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI), and mortality remains excessive in high-risk subgroups.1-4 Despite normal epicardial Thrombolysis in Myocardial Infarction (TIMI) flow after primary PCI, myocardial perfusion (as assessed either by angiographic capillary opacification [myocardial blush] or electrocardiographic ST-segment resolution [STR]) is abnormal in a significant proportion of patients, contributing to increased infarct size and reduced survival.5-15 Recent studies have emphasized the ubiquitous occurrence of distal embolization of atheromatous and thrombotic debris after primary PCI, potentially resulting in microcirculatory dysfunction, abnormal myocardial metabolism, and increased myonecrosis.16-18 Pilot studies and small randomized trials have demonstrated that distal protection of the microcirculation during primary PCI retrieves embolic debris in more than 70% of patients and may result in greater rates of normal TIMI flow and blush, complete STR, improved left ventricular function, and enhanced event-free survival compared with either historical or concurrent controls.19-25 We therefore performed a large-scale pivotal trial to evaluate the usefulness of distal microcirculatory protection during mechanical reperfusion therapy in AMI.

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