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European Heart Journal Advance Access published online on February 1, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi755
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received October 20, 2005
Revised December 11, 2005
Accepted January 13, 2006

Review

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

Ugo Limbruno 1 and Raffaele De Caterina 2 *

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; CNR Institute of Clinical Physiology, Pisa, Italy

* To whom correspondence should be addressed.
Raffaele De Caterina, E-mail: rdecater{at}unich.it


  Abstract

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.

Keywords: Myocardial infarction; Percutaneous coronary interventions; Angioplasty; Embolization; Reperfusion.
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