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J Am Coll Cardiol, 2005; 46:1434-1445, doi:10.1016/j.jacc.2005.04.061 (Published online 27 September 2005).
© 2005 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPERS

Distal Myocardial Protection During Percutaneous Coronary Intervention

When and Where?

Diana A. Gorog, MD, PhD, MRCP*, Rodney A. Foale, MD, FRCP and Iqbal Malik, PhD, MRCP

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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