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European Heart Journal Advance Access published online on January 19, 2009
European Heart Journal, doi:10.1093/eurheartj/ehn594
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Predictors and time-related impact of distal embolization during primary angioplasty

Massimo Napodano1,*, Angelo Ramondo1, Giuseppe Tarantini1, Diletta Peluso1, Silvia Compagno1, Chiara Fraccaro1, Anna Chiara Frigo2, Renato Razzolini1 and Sabino Iliceto1

1 Cardiac Catheterization Laboratories and Interventional Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 2 via Giustiniani, 35100 Padova, Italy
2 Department of Environmental Medicine and Public Health, University of Padova, Italy

Received 7 January 2008; revised 7 November 2008; accepted 22 December 2008.

* Corresponding author. Tel: +39 0498211844, Fax: +39 0498761764, Email: massimo.napodano{at}gmail.com

Aims: We sought to identify predictors of distal embolization (DE) occurring during primary percutaneous coronary intervention (p-PCI) as well as to assess its impact on both myocardial reperfusion and necrosis, according to time-to-treatment.

Methods and results: Clinical and angiographic characteristics were prospectively assessed in 400 consecutive patients who underwent p-PCI, in order to identify predictors of DE. The impact of DE on Thrombolysis in Myocardial Infarction (TIMI) flow, myocardial blush, and troponin I (TnI) was assessed according to symptom onset-to-balloon time. DE occurred in 64 (16%) patients and did not change with time-to-treatment (P = 0.87). The occlusion pattern of infarct-related artery (IRA), treatment of right coronary artery, higher TIMI thrombus score, longer lesion, and large IRA diameter were predictors of DE. The rate of TIMI 0/1 and myocardial blush 0/1 was higher in patients exhibiting DE when time-to-treatment was ≤6 h (P < 0.0001), while TnI was higher in patients with DE when time-to-treatment was <3 h.

Conclusion: DE during p-PCI occurs more often in the presence of high thrombus burden lesion. It reduces the effectiveness of myocardial reperfusion within 6 h and enhances myocardial damage within 3 h after symptom onset. Afterwards, it does not affect myocardial reperfusion or the extent of myocardial damage.

Key Words: Distal embolization • Myocardial infarction • Myocardial reperfusion • Primary angioplasty • Thrombus


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