Contemporary outcomes of rescue percutaneous coronary intervention for acute myocardial infarction: Comparison with primary angioplasty and the role of distal protection devices (EMERALD trial)
Contemporary outcomes of rescue percutaneous coronary intervention for acute myocardial infarction: Comparison with primary angioplasty and the role of distal protection devices (EMERALD trial)
复制标题
DOI：
10.1016/j.ahj.2007.12.003
复制
发表时间：
2008-06-01
影响因子：
4.8
通讯作者：
Mehran, Roxana
中科院分区：
文献类型：
--
作者：
Dangas, George;Stone, Gregg W.;Mehran, Roxana
背景远端保护装置在PCI抢救中的应用价值尚未得到研究。方法：纳入st段抬高心肌梗死远端微循环保护的前瞻性、随机多中心试验的人群，对接受抢救（n = 93）或初级PCI （n = 408）的患者进行分层；我们对抢救和初次PCI的远端保护进行了预先指定的比较。结果与初次PCI相比，抢救患者的基线TIMI-3血流率较高，但PCI后TIMI-3血流率较低。然而，在30分钟完全st段消退（STR）、梗死面积或6个月死亡率的主要终点方面没有差异。在抢救PCI患者中，随机分配到远端保护对梗死面积、STR、死亡率或其他临床事件没有显著影响。结论尽管术后TIMI-3血流率降低，但与初次PCI相比，接受抢救PCI的患者心肌灌注、梗死面积和临床结果相似。在该患者群体中，远端保护没有提供任何可检测的益处。
Background The value of distal protection devices during rescue PCI has not been studied.Methods The population enrolled in a prospective, randomized multicenter trial of distal microcirculatory protection in ST-elevation MI, was stratified for those undergoing rescue (n = 93) or primary (n = 408) PCI; we performed the prespecified comparisons of distal protection in rescue and primary PCI.Results Compared to primary PCI, rescue patients had higher baseline rates of TIMI-3 flow, but lower rates of post PCI TIMI-3 flow. However, no differences in the primary endpoints of complete ST-segment resolution (STR) at 30 minutes or infarct size, or 6 month mortality were present. In rescue PCI patients, randomization to distal protection did not significantly affect infarct size, STR, mortality or other clinical events.Conclusion Despite reduced rates of post-procedural TIMI-3 flow, patients undergoing rescue PCI compared to primary PCI have similar myocardial perfusion, infarct size and clinical outcomes. Distal protection did not offer any detectable benefit in this patient population.