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.
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.
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.