Heart Attack :: Treatment of blockages in patients suffering severe heart attacks

Severe heart attacks are often treated with non-surgical procedures that open narrowed or blocked arteries of the heart using stents (percutaneous coronary intervention, or PCI).

Because these procedures often carry risks for complications, researchers are studying opportunities to enhance the efficacy and safety of these procedures to improve overall patient survival and quality of life.

A study presented today at the American College of Cardiology?s Innovation in Intervention: i2 Summit explores the outcomes of using distal protection (a device positioned just beyond the blockage to catch debris and prevent them from lodging in another downstream blood vessel during PCI) with PCI to treat patients who suffer from a major heart attack. Innovation in Intervention: i2 Summit is an annual meeting for practicing cardiovascular interventionalists sponsored by the American College of Cardiology in partnership with the Society for Cardiovascular Angiography and Interventions.

In this study, known as DEDICATION, investigators examined two methods to treat ST- elevation myocardial infarction (STEMI), a heart attack caused by a complete blockage in an artery of the heart: a conventional PCI (stent implantation only) or distal protection (stent implantation and filterwire). Researchers looked at several factors to determine which strategy would provide the best outcome for the 626 patients in the trial: major adverse cardiac and cerebral events, electrocardiographic results (measurements of the heart?s pumping ability) and enzymatic levels.

One month after PCI for STEMI, researchers found no significant differences between the two groups. Electrocardiographic, enzymatic and functional effects were similar in patients who received both conventional PCI and distal protection. However, post-procedure blood flow seemed to be improved in patients treated with distal protection. Results also showed that patients in both groups had similar rates of complications, specifically MACCE (major adverse cardiac and cerebral events, including death, myocardial infarction, stroke or symptom-driven revascularization); 4.4 percent of patients in the conventional treatment group experienced MACCE compared with 6.5 percent in the distal protection group.

?With conflicting reports of distal protection use in STEMI patients, our study sought to determine if filterwires could improve outcomes,? said Leif Thuesen, M.D., F.E.S.C., Aarhus University Hospital, Skejby, Denmark and lead study author. ?While we hoped to see a change in outcomes, we cannot exclude that the combination strategy might deliver better outcomes in subgroups of patients, and that the improved blood flow in the filterwire treated patients might have beneficial effects on long-term out come.?


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