Impact of Distal Protection with Filter-Type Device on Long-term Outcome after Percutaneous Coronary Intervention for Acute Myocardial Infarction: Clinical Results with Filtrap

• Published in: Journal of Atherosclerosis and Thrombosis Vol. 23; no. 12; pp. 1313 - 1323
• Main Authors: Teramoto, Ryota, Sakata, Kenji, Miwa, Kenji, Matsubara, Takao, Yasuda, Toshihiko, Inoue, Masaru, Okada, Hirofumi, Kanaya, Honin, Kawashiri, Masa-aki, Yamagishi, Masakazu, Hayashi, Kenshi
• Format: Journal Article
• Language: English
• Published: Japan Japan Atherosclerosis Society 01-12-2016
• Subjects: Acute myocardial infarction; Aged; Angioplasty, Balloon, Coronary - methods; Distal protection; Electrocardiography - methods; Embolic Protection Devices - utilization; Female; Filtration - instrumentation; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - prevention & control; Humans; Male; Middle Aged; Myocardial Infarction - surgery; Original; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Prognosis
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.34215

Aim: Although distal embolization during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) deteriorates cardiac function, whether distal protection (DP) can improve prognosis is still controversial. We investigated whether a filter-type DP device, Filtrap®, could improve long-term outcomes after PCI for AMI.Method: We studied 164 patients (130 men, mean age: 65.7 years) who underwent PCI. Patients were divided into two groups based on the use of Filtrap®. The occurrence of congestive heart failure (CHF) and major adverse cardiac events (MACE) defined as cardiac death, recurrent AMI, and target vessel revascularization were compared.Result: Between DP (n=53, 41 men, mean age: 65.5 years) and non-DP (n=111, 89 men, mean age: 65.8 years) groups, although there was significantly greater plaque area in the DP group than in the non-DP group, there were no significant differences in coronary reperfusion flow after PCI. Interestingly, patients with CHF in the non-DP group exhibited a higher CK level than those in the DP group. During a 2-year follow-up period, cumulative CHF was significantly lower in the DP group than in the non-DP group (log-rank p=0.018), and there was no significant difference in the MACE rate (log-rank p=0.238). The use of DP device could not predict MACE, but could predict CHF by multivariate analysis (odds ratio=0.099, 95% CI: 0.02–0.42, p=0.005).Conclusion: These results demonstrate that favorable clinical outcomes could be achieved by the filter-type DP device in AMI, particularly in patients with CHF.