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Distal Myocardial Protection During Percutaneous Coronary Intervention

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Waller Cardiac Department, St. Mary’s Hospital, London, United Kingdom

Manuscript received February 5, 2005; revised manuscript received April 12, 2005, accepted April 15, 2005.

^_* Reprint requests and correspondence: Dr. Diana A. Gorog, Waller Cardiac Department, St. Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom (Email: dgorog{at}aol.com).

The discrepancy between angiographic success and microvascular perfusion has been recognized for some time. In the face of an open artery, the degree of microvascular perfusion determines post-infarct prognosis. Despite successful epicardial recanalization, tissue perfusion may be absent in up to 25% patients with acute myocardial infarction. Historically associated with saphenous vein graft intervention, embolization is increasingly recognized in native coronary arteries, particularly in patients undergoing primary percutaneous coronary intervention (PCI). With more than two million PCI procedures performed worldwide each year, there is enormous interest in protecting the left ventricular myocardium from embolization during PCI. This article reviews the evidence for distal myocardial protection and discusses the relative merits of the different available techniques.

Abbreviations and Acronyms   AMI = acute myocardial infarction   ACS = acute coronary syndromes   CAPTIVE = CardioShield Application Protects During Transluminal Intervention of Vein Grafts by Reducing Emboli   CAS = carotid artery stenting   DPD = distal protection device   GP = glycoprotein   MACE = major adverse cardiac event   MBG = myocardial blush grade   MMP9 = matrix metalloproteinase 9   PCI = percutaneous coronary intervention   PRIDE = PRotection During Saphenous Vein Graft Intervention to Prevent Distal Embolization   SAFE = Saphenous Vein Graft Angioplasty Free of Emboli trial   SAFER = Saphenous Vein Graft Angioplasty Free of Emboli Randomized trial   SVG = saphenous vein graft

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