Limbruno Ugo, Micheli Andrea, De Carlo Marco, Amoroso Giovanni, Rossini Roberta, Palagi Caterina, Di Bello Vitantonio, Petronio Anna Sonia, Fontanini Gabriella, Mariani Mario
Cardiac and Thoracic Department, University of Pisa, Pisa, Italy.
Circulation. 2003 Jul 15;108(2):171-6. doi: 10.1161/01.CIR.0000079223.47421.78. Epub 2003 Jun 30.
Effective myocardial reperfusion after primary percutaneous coronary intervention (PCI) may be limited by distal embolization. We tested the safety, feasibility, and efficacy of the FilterWire-Ex (FW), a distal embolic protection device, as an adjunct to primary PCI.
Fifty-three consecutive patients undergoing primary PCI with FW protection were compared with a matched control group treated by primary PCI alone. Successful FW positioning was obtained in 47 patients (89%) without complications. Histological analysis of the content of the last 13 filters showed multiple embolic debris in all cases. FW use was associated with lower postinterventional corrected TIMI frame count (22+/-14 versus 31+/-19; P=0.005) and higher occurrence of grade 3 myocardial blush (66% versus 36%; P=0.006) and early ST-segment elevation resolution (80% versus 54%; P=0.006). At multivariate analysis, FW use was the only independent predictor of early ST-segment elevation resolution and of grade 3 myocardial blush. FW patients showed lower peak creatine kinase-MB release (236+/-172 versus 333+/-219 ng/mL; P=0.013) and greater improvement at 30 days in left ventricular wall motion score index (-0.30+/-0.19 versus -0.18+/-0.26; P=0.008) and ejection fraction (+7+/-4% versus +4+/-7%; P=0.012).
FW use during primary PCI is feasible and safe. Distal embolization prevention appears to exert a beneficial effect on markers of myocardial reperfusion and on left ventricular function improvement at 30 days.
直接经皮冠状动脉介入治疗（PCI）后有效的心肌再灌注可能会受到远端栓塞的限制。我们测试了远端栓塞保护装置FilterWire-Ex（FW）作为直接PCI辅助手段的安全性、可行性和有效性。
将53例连续接受FW保护的直接PCI患者与单纯接受直接PCI治疗的匹配对照组进行比较。47例患者（89%）成功放置FW且无并发症。对最后13个过滤器的内容物进行组织学分析，结果显示所有病例均有多个栓塞碎片。使用FW与介入治疗后校正的TIMI帧数较低（22±14对31±19；P = 0.005）、3级心肌显影发生率较高（66%对36%；P = 0.006）以及早期ST段抬高缓解率较高（80%对54%；P = 0.006）相关。在多变量分析中，使用FW是早期ST段抬高缓解和3级心肌显影的唯一独立预测因素。使用FW的患者肌酸激酶-MB释放峰值较低（236±172对333±219 ng/mL；P = 0.013），30天时左心室壁运动评分指数改善更大（-0.30±0.19对-0.18±0.26；P = 0.008），射血分数增加更多（+7±4%对+4±7%；P = 0.012）。
直接PCI期间使用FW是可行且安全的。预防远端栓塞似乎对心肌再灌注标志物以及30天时左心室功能的改善产生有益影响。
