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Predictors and clinical significance of angiographically detected distal embolization after primary percutaneous coronary interventions

Izgi, Akina; Kirma, Cevata; Tanalp, Ali Cevata; Dundar, Cihana; Oduncu, Veciha; Aung, Soe Moea; Sonmez, Kenana; Mutlu, Bulenta; Mansuroglu, Denyanb

doi: 10.1097/MCA.0b013e3282a3064e
Pathophysiology and Natural History
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Objectives The aim of this study was to investigate clinical, angiographic and procedural predictors of distal embolization (DE) on angiography after primary percutaneous coronary intervention (PCI). The impact of DE on outcome in the first 30 days was also assessed.

Methods Between January 2004 and April 2006, primary PCI was performed in 212 consecutive patients with acute myocardial infarction (AMI) of ≤12-h duration.

Results Distal embolization was present in 27 patients (12.7%) and more often observed in female sex (27.5 vs. 10.4%, P=0.01), in patients with right coronary artery involvement (52 vs. 28%, P=0.02), prerevascularization thrombolysis in myocardial infarction flow ≤1 (89 vs. 69%, P=0.03), in the presence of high thrombus burden (92.6 vs. 39.5%, P=0.0009), and a long target lesion in the infarct-related artery (>14.5 mm, 74 vs. 29%, P<0.0001). By multiple stepwise logistic regression analysis, only the presence of high thrombus burden before the PCI procedure [odds ratio (OR)=5.2, 95% confidence interval (CI)=1.09–24.97, P=0.03)] and target lesion length (>14.5 mm, OR=3.9, 95% CI=1.45–10.60, P=0.007) were found independent predictors of DE. Patients with DE had an increased risk of target vessel revascularization (26 vs. 5%, P=0.001) and short-term mortality (29.6 vs. 7.5%, P=0.002) when compared with patients without angiographic signs of embolization.

Conclusions In patients who undergo primary PCI, high thrombus burden on angiography before PCI and/or a long target lesion in the infarct-related artery increase the risk of DE and subsequent short-term mortality.

Departments of aCardiology

bCardiovascular Surgery, Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital, Kartal, Istanbul, Turkey

Correspondence to Dr Akin Izgi, MD, Kartal Kosuyolu Yuksek Ihtisas Hastanesi, Kardiyoloji klinigi 34846, Kartal, Istanbul, Turkey

Tel: +90 542 651 24 64; fax: +90 216 459 63 21;

e-mail: akinizgi@hotmail.com

Received 11 September 2006 Revised 3 May 2007 Accepted 16 May 2007

© 2007 Lippincott Williams & Wilkins, Inc.