European Heart Journal Advance Access originally published online on February 18, 2009
European Heart Journal 2009 30(8):908-915; doi:10.1093/eurheartj/ehp033
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Incidence and clinical consequences of distal embolization on the coronary angiogram after percutaneous coronary intervention for ST-elevation myocardial infarction
1 Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB Groningen, The Netherlands
2 Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Received 18 December 2008; accepted 8 January 2009; online publish-ahead-of-print 18 February 2009.
* Corresponding author. Tel: +31 50 3610444, Fax: +31 50 3614391, Email: m.l.fokkema{at}thorax.umcg.nl
Aims: We investigated the incidence and sequelae of angiographically visible distal embolization (AVDE) after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction patients treated with aspirin, heparin, clopidogrel, and glycoprotein-IIb/IIIa inhibitors.
Methods and results: As part of TAPAS, AVDE was a predefined secondary endpoint. We compared angiographic and clinical characteristics, and outcomes of patients with and without AVDE after PCI. AVDE was present on 6.3% of 883 post-procedural angiograms. Angiographically visible distal embolization was associated with significantly worse outcomes, as expressed by lower myocardial blush grade, impaired ST-segment resolution, and higher enzyme levels (all P 
0.001). Mortality 1 year after PCI was 4 of 56 (7.1%) in patients with AVDE and 43 of 827 (5.2%) in patients without AVDE (P= ns), re-infarction occurred in 5 of 56 (8.9%), and 25 of 827 (3.0%) patients (P = 0.018). The thrombus aspirate more often contained erythrocytes in patients with AVDE than in patients without AVDE (50.0% vs. 15.7%, P < 0.001), and the size of the aspirated thrombus was larger in patients with AVDE (P = 0.002).
Conclusion: In patients with triple anti-platelet therapy, the incidence of AVDE after PCI is low, compared with previous reports. Nevertheless, AVDE is associated with impaired myocardial reperfusion and poor outcome. Thrombus composition and size are related to AVDE after PCI.
Key Words: ST-elevation myocardial infarction • Reperfusion • Angioplasty • Distal embolization
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