The Distal Protection During Primary Percutaneous Coronary Intervention Alleviates the Adverse Effects of Large Thrombus Burden on Myocardial Reperfusion

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• Background The presence of intracoronary large thrombus burden (LTB) in the infarct-related artery increases the risk of distal embolization and no-reflow during percutaneous coronary intervention (PCI). Evaluation of whether the distal protection (DP) during primary PCI reduces adverse effects of LTB on myocardial reperfusion and infarct size was investigated. Methods and Results A consecutive series of 88 patients with acute myocardial infarction undergoing primary PCI using DP were compared with 81 consecutive patients treated by primary PCI alone. The DP use showed similar post-procedural myocardial blush grade (MBG)-3 and infarct size, but improved corrected thrombolysis in myocardial infarction frame count (cTFC) (29±11 vs 35±20, p=0.011) and the incidence of ST-segment resolution (80.7% vs 66.7%, p=0.038). In patients with LTB present, however, the DP use reduced occurrences of no-reflow (0% vs 11.8%, p=0.036) and distal embolization (4.8% vs 17.6%, p=0.129), resulting in higher occurrences of MBG-3 (61.9% vs 35.3%, p=0.021) and ST-segment resolution (78.6% vs 50.0%, p=0.009), lower cTFC values (30±8 vs 40±22, p=0.012) and smaller infarct size (12.2±11.2 vs 18.7±11.1, p=0.015). Conclusions With an improved myocardial reperfusion and smaller infarct size in patients with LTB, the DP during primary PCI might be a better strategy in this particular setting compared with conventional strategy.

• 社団法人日本循環器学会の論文
• 2006-02-20

著者

• MUROHARA Toyoaki

  Nagoya University

• Yamada Takumi

  Division Of Cardiovascular Disease University Of Alabama At Birmingham

• Okada Taro

  Division Of Cardiology Aichi Prefecture Cardiovascular And Respiratory Center

• Nagata Kohzo

  Department of Medical Technology, Nagoya University School of Health Sciences

• Umeda Hisashi

  Division Of Cardiology Toyota Memorial Hospital

• Shimizu Takeshi

  Department Of Cardiology Aichi Cardiovascular And Respiratory Center

• MURAKAMI Yoshimasa

  Division of Cardiology, Aichi Prefecture Cardiovascular and Respiratory Center

• Shimizu Takeshi

  Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center

• Nagata Kohzo

  名古屋大学 医学系研究科病態解析学

• Nagata Kohzo

  名古屋大学 医学系研究科医療技術科学専攻

• Nagata Kohzo

  名古屋大学 医学系研究科循環器ゲノム情報応用診断学

• Iwase Mitsunori

  Division of Integrated Medicine, Toyota Memorial Hospital

• Yokota Mitsuhiro

  Department Of Genome Science School Of Dentistry Aichi-gakuin University

• Yokota Mitsuhiro

  Department Of Clinical Pathophysiology Nagoya University Graduate School Of Medicine

• Kato Tomoko

  Department Of Organ Transplantation National Cardiovascular Center

• Izawa Hideo

  Division Of Cardiology Fujita Health University Hospital

• Murakami Yoshimasa

  Division Of Cardiology Aichi Prefecture Cardiovascular And Respiratory Center

• Yoshikane Mari

  Department Of Cardiology Chunichi Hospital

• Nakamura Kae

  名古屋大学 循環病態探索医療学

• Iwase M

  Pathophysiological Laboratory Sciences Graduate School Of Medicine Nagoya University

• Izawa Hideo

  Nagoya University Graduate School of Medicine, Division of Cardiology

• Watanabe Kosuke

  Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center

• Matsushita Toyoaki

  Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center

• Tani Tomomitsu

  Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center

• Iwase Mitsunori

  名古屋大学 医学系研究科医療技術科学専攻

• Okamoto Mitsuhiro

  Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center

• Katoh Toshiaki

  Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center

• Iwase Mitsunori

  Division Of Acute Coronary Syndrome Aichi Council Of Advanced Emergency Care

• Iwase Mitsunori

  School Of Health Sciences Nagoya University

• Nagata Kohzo

  Department Of Medical Technology Nagoya University School Of Health Sciences

• Izawa Hideo

  Department Of Cardiology

• Kato Tomoko

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Tani Tomomitsu

  Division Of Cardiology Aichi Cardiovascular And Respiratory Center

• Okamoto Mitsuhiro

  Division Of Cardiology Aichi Prefectural Cardiovascular And Respiratory Center

• Umeda Hisashi

  Aichi Prefectural Owari Hospital Cardiovascular Center

• Katou Tomoko

  Division Of Organ Transplantation National Cardiovascular Center

• Yokota Mitsuhiro

  Division Of Cardiology Gifu Social-insurance Hospital

• Iwase Mitsunori

  Pathophysiological Laboratory Sciences Graduate School Of Medicine Nagoya University

• Yokota Mitsuhiro

  Department Clinical Laboratory Nagoya University Hospital

• Watanabe Kosuke

  Division Of Cardiology Aichi Cardiovascular And Respiratory Center

• Ohno Miyoshi

  岐阜県立多治見病院 循環器内科

• Iwase Masatsugu

  Division Of Integrated Medicine Toyota Memorial Hospital

• Iwase Mitsunori

  Department Of Medical Technology Nagoya University School Of Health Sciences

• Yokota Mitsuhiro

  Nagoya University College Of Medical Technology Cardiovascular Section Department Of Clinical Labora

• Okamato Mitsuhiro

  岐阜県立多治見病院 循環器内科

• Takagi Katsumasa

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Nagata Kozo

  Graduate School Of Medicine Nagoya University

• Nagata Kohzo

  Department Of Medical Technology School Of Health Sciences Nagoya University

• Kato Tomoko

  Organ Transplantation National Cardiovascular Center

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