| 정우영¹ ², 조영석¹ ² , 최상일³ , 장혁재¹ ² , 한미정¹ , 박해준¹ , 윤현미¹ , 채인호¹ ² , 최동주¹ ² , 오병희² ⁴, 박영배² ⁴ |
Background : This prospective randomized study was designed to validate the efficacy of Percusurge guardwire on infarct size, ventricular remodeling and micorvascular obstruction.
Methods : ST elevation acute myocardial infarction (STEMI) patients with onet time of 12hr were randomly assigned into Percusurge guardwire group (group P), no Percusurge guardwire group (group N). Primary PCI was performed with standard method. Drug eluting stents were implanted in all patients. Immediate after PCI, antegrade flow and myocardial perfusion were evaluated according to TIMI, TMP grading, respectively. QCA (quantitative coronary angiography) analysis, at the time of immediate post PCI and 6 months follow up, and clinical outcome during follow up period. Before the discharge, Cardiac MRI imagings were obtained, including adenosine, dobutamine stress imaging. Microvascular obstruction (MVO) was graded in perfusion imaging. Grade III means severe degree of MVO showing no evidence of microperfusion after 10 minutes of contrast injection.
Results : 67 patients were enrolled and among them, 40 patients including 2 mortality cased finished 6 months follow up. No difference was found in demographic characteristics and major risk factors.. stent was longer in group P (27.23±4.59mm vs 24.36mm, p=0.03) and similar in diameter (3.17±0.45mm vs 3.10±0.49mm, p=0.48). QCA analysis showed no difference in post PCI reference diameter, late loss (0.23mm vs 0.02mm, p=0.20), post PCI and follow up diameter stenosis (12.07±7.13% vs 10.89±6.13%, p=0.47; 21±18% vs 14±11%, p=0.13), restenosis rate (5% vs 11%, p=0.23) Distal protection didn’t show any benefit in terms of left ventricular volume, infarction size measured by cardiac MRI, post PCI and 6 mo follow-up. Echocardiographic and MRI ejection fraction had no difference both at baseline and 6 months follow up. TMP Grade III was 40% in group P, 29% in group N,(p=0.07) MVO Grade0/I was 27% in group P, 35% in group N immediately after PCI
Conclusion : Distal protection device have tendency to improve microvascular perfusion but it seems not to lead to clinical benefit such as inhibition of ventricular remodeling and dysfunction.
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