Correlations between epicardial flow, microvascular reperfusion, infarct size and clinical outcomes in patients with anterior versus non-anterior myocardial infarction treated with primary or rescue angioplasty: analysis from the EMERALD trial.

Journal Article

AIMS: We compared epicardial and microvascular reperfusion, infarct size, and clinical outcomes after primary and rescue PCI with and without GuardWire distal protection in patients with LAD vs. non-LAD acute myocardial infarction (AMI). In the general AMI population undergoing primary PCI, the use of GuardWire did not yield higher reperfusion success, reduced infarct size, or enhanced event-free survival. Whether GuardWire is beneficial in patients with AMI in certain territories of the coronary circulation is unknown. METHODS AND RESULTS: In the EMERALD trial, 501 patients with AMI were randomised to PCI with vs. without distal protection. The outcomes were analysed as a function of culprit vessel (LAD vs. non-LAD) and the use of GuardWire. Patients with LAD vs. non-LAD infarcts had significantly (P< or =0.0001) lower rates of final TIMI flow grade 3 (85.2% vs. 94.4%), myocardial blush grade 3 (40.1% vs. 67.6%), and complete ST-segment resolution (35.1% vs. 79.6%). Patients with LAD infarcts also had larger infarct size (25.8+/-21.8% vs. 11.3_13.7%, p<0.0001) and a trend towards higher rates of 6-month mortality (5.5% vs. 2.1%, p=0.09) and new-onset severe heart failure (3.5% vs. 1.1%, p=0.08). Rates of reperfusion were not related to GuardWire use in patients with LAD infarcts. In patients with non-LAD infarcts, the use of GuardWire was associated with a trend towards better epicardial and microvascular reperfusion. CONCLUSIONS: Myocardial infarction in the territory of the LAD is associated with worse epicardial and microvascular reperfusion and worse 6-month clinical outcomes. Use of the GuardWire showed a trend towards better epicardial and microvascular flow in patients with a non-LAD infarct-related artery.

Full Text

Duke Authors

Cited Authors

  • Nikolsky, E; Stone, GW; Lee, E; Lansky, AJ; Webb, J; Cox, DA; Brodie, BR; Turco, MA; Rutherford, BD; Kalynych, AM; Antoniucci, D; Krucoff, MW; Gibbons, RJ; Fahy, M; Mehran, R

Published Date

  • September 2009

Published In

Volume / Issue

  • 5 / 4

Start / End Page

  • 417 - 424

PubMed ID

  • 19755327

International Standard Serial Number (ISSN)

  • 1774-024X

Language

  • eng

Conference Location

  • France