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European Heart Journal Advance Access originally published online on February 1, 2006
European Heart Journal 2006 27(10):1139-1145; doi:10.1093/eurheartj/ehi755
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

EMERALD, AIMI, and PROMISE: is there still a potential for embolic protection in primary PCI?

Ugo Limbruno1 and Raffaele De Caterina2,3,*

1 Cardiology Unit, Cardiovascular Department, ASL 6, Livorno, Italy
2 Department of Cardiology, Center of Excellence on Aging, ‘G. d'Annunzio’ University of Chieti, C/o Ospedale S. Camillo de Lellis Via Forlanini, 50 66100 Chieti, Italy
3 CNR Institute of Clinical Physiology, Pisa, Italy

Received 20 October 2005; revised 11 December 2005; accepted 13 January 2006; online publish-ahead-of-print 1 February 2006.

* Corresponding author. Tel: +39 0871 41512; fax: +39 0871 402817. E-mail address: rdecater{at}unich.it

The recent trials of routine use of embolic protection devices for primary percutaneous coronary interventions (PCI) (the EMERALD, PROMISE, and AIMI trials) have demonstrated neutral or even negative effects of these devices on myocardial reperfusion and final infarct size. Despite these results, there is still ground to believe that PCI-induced embolization may be clinically relevant in specific subsets of patients with acute myocardial infarction (AMI). Significant clinical consequences may be expected when embolization is quantitatively relevant and/or is qualitatively characterized by lipid-rich athero-embolism (as is the case of lipid core embolization through the ruptured cap of a fibro-atheroma). Future trials on embolic protection devices in primary PCI should adopt a selective, rather than a routine strategy, through the identification, by angiographic or intravascular imaging parameters, of patients at highest risk of clinically relevant embolization. Such trials should also adopt specific endpoints able to evaluate the effect of micro-embolization, which is currently far from optimally assessed by the standard markers of myocardial reperfusion.

Key Words: Myocardial infarction • Percutaneous coronary interventions • Angioplasty • Embolization • Reperfusion


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