Distal embolic protection during percutaneous coronary intervention in patients with acute coronary syndromes

The RUBY study

Antonio L. Bartorelli, Tian Hai Koh, Francesco Di Pede, Bernard Reimers, Leif Thuesen, Franz W. Amann, Franco Fabbiocchi, Harry Suryapranata

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To assess the safety and feasibility of the GuardWire™ system as an embolic protection device during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Background: Distal embolization occurs in approximately 15% of patients after primary angioplasty and is associated with reduced myocardial reperfusion, more extensive myocardial damage and a poor prognosis. Distal embolic protection could reduce the rate of embolic complications and improve outcome. Methods: 329 patients (mean age 60 ± 12 years) were included: 278 (84.5%) with ST-elevation myocardial infarction (STEMI), 50 (15.2%) with unstable angina/non-STEMI and 1 (0.3%) with post-infarction angina. Primary endpoint was the incidence of major adverse cardiac events (MACE) at 30 days. Secondary endpoints were the magnitude of ST-segment resolution at 90 and 180 min post-procedure, myocardial blush grade, and angiographically visible distal emboli. Results: The GuardWire™ system was successfully positioned in 99% of patients. Complete ST-elevation resolution (>70%) was observed in 28.5% immediately post-procedure, and in 35.4% and 41.6% at 90 and 180 min post-procedure. TIMI-3 flow grade was achieved by 89.8% of patients after intervention and mean corrected TIMI frame count was 20.2 ± 13.2. Grade-3 myocardial blush was seen in 47.7% of patients and distal emboli were angiographically visible in 7.4%. Incidence of MACE at 30 days was 3.3% (death 1.2%; Q-wave MI 0.3%; non-Q-wave MI 0.3%; coronary artery bypass graft 0.6%; repeat PCI 0.9%). Conclusion: The GuardWire™ system was successfully positioned in nearly all patients without complications. The use of this embolic protection device in ACS patients undergoing PCI was associated with low rates of distal embolization and 30-day MACE.

Original languageEnglish
Pages (from-to)148-154
Number of pages7
JournalAcute Cardiac Care
Volume8
Issue number3
DOIs
Publication statusPublished - Oct 1 2006

Fingerprint

Percutaneous Coronary Intervention
Acute Coronary Syndrome
Embolic Protection Devices
Embolism
Myocardial Reperfusion
Incidence
Unstable Angina
Angioplasty
Coronary Artery Bypass
Infarction
Transplants
Safety

Keywords

  • Angioplasty
  • Distal protection
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Emergency Medicine

Cite this

Distal embolic protection during percutaneous coronary intervention in patients with acute coronary syndromes : The RUBY study. / Bartorelli, Antonio L.; Koh, Tian Hai; Di Pede, Francesco; Reimers, Bernard; Thuesen, Leif; Amann, Franz W.; Fabbiocchi, Franco; Suryapranata, Harry.

In: Acute Cardiac Care, Vol. 8, No. 3, 01.10.2006, p. 148-154.

Research output: Contribution to journalArticle

Bartorelli, Antonio L. ; Koh, Tian Hai ; Di Pede, Francesco ; Reimers, Bernard ; Thuesen, Leif ; Amann, Franz W. ; Fabbiocchi, Franco ; Suryapranata, Harry. / Distal embolic protection during percutaneous coronary intervention in patients with acute coronary syndromes : The RUBY study. In: Acute Cardiac Care. 2006 ; Vol. 8, No. 3. pp. 148-154.
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T2 - The RUBY study

AU - Bartorelli, Antonio L.

AU - Koh, Tian Hai

AU - Di Pede, Francesco

AU - Reimers, Bernard

AU - Thuesen, Leif

AU - Amann, Franz W.

AU - Fabbiocchi, Franco

AU - Suryapranata, Harry

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N2 - Objective: To assess the safety and feasibility of the GuardWire™ system as an embolic protection device during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Background: Distal embolization occurs in approximately 15% of patients after primary angioplasty and is associated with reduced myocardial reperfusion, more extensive myocardial damage and a poor prognosis. Distal embolic protection could reduce the rate of embolic complications and improve outcome. Methods: 329 patients (mean age 60 ± 12 years) were included: 278 (84.5%) with ST-elevation myocardial infarction (STEMI), 50 (15.2%) with unstable angina/non-STEMI and 1 (0.3%) with post-infarction angina. Primary endpoint was the incidence of major adverse cardiac events (MACE) at 30 days. Secondary endpoints were the magnitude of ST-segment resolution at 90 and 180 min post-procedure, myocardial blush grade, and angiographically visible distal emboli. Results: The GuardWire™ system was successfully positioned in 99% of patients. Complete ST-elevation resolution (>70%) was observed in 28.5% immediately post-procedure, and in 35.4% and 41.6% at 90 and 180 min post-procedure. TIMI-3 flow grade was achieved by 89.8% of patients after intervention and mean corrected TIMI frame count was 20.2 ± 13.2. Grade-3 myocardial blush was seen in 47.7% of patients and distal emboli were angiographically visible in 7.4%. Incidence of MACE at 30 days was 3.3% (death 1.2%; Q-wave MI 0.3%; non-Q-wave MI 0.3%; coronary artery bypass graft 0.6%; repeat PCI 0.9%). Conclusion: The GuardWire™ system was successfully positioned in nearly all patients without complications. The use of this embolic protection device in ACS patients undergoing PCI was associated with low rates of distal embolization and 30-day MACE.

AB - Objective: To assess the safety and feasibility of the GuardWire™ system as an embolic protection device during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Background: Distal embolization occurs in approximately 15% of patients after primary angioplasty and is associated with reduced myocardial reperfusion, more extensive myocardial damage and a poor prognosis. Distal embolic protection could reduce the rate of embolic complications and improve outcome. Methods: 329 patients (mean age 60 ± 12 years) were included: 278 (84.5%) with ST-elevation myocardial infarction (STEMI), 50 (15.2%) with unstable angina/non-STEMI and 1 (0.3%) with post-infarction angina. Primary endpoint was the incidence of major adverse cardiac events (MACE) at 30 days. Secondary endpoints were the magnitude of ST-segment resolution at 90 and 180 min post-procedure, myocardial blush grade, and angiographically visible distal emboli. Results: The GuardWire™ system was successfully positioned in 99% of patients. Complete ST-elevation resolution (>70%) was observed in 28.5% immediately post-procedure, and in 35.4% and 41.6% at 90 and 180 min post-procedure. TIMI-3 flow grade was achieved by 89.8% of patients after intervention and mean corrected TIMI frame count was 20.2 ± 13.2. Grade-3 myocardial blush was seen in 47.7% of patients and distal emboli were angiographically visible in 7.4%. Incidence of MACE at 30 days was 3.3% (death 1.2%; Q-wave MI 0.3%; non-Q-wave MI 0.3%; coronary artery bypass graft 0.6%; repeat PCI 0.9%). Conclusion: The GuardWire™ system was successfully positioned in nearly all patients without complications. The use of this embolic protection device in ACS patients undergoing PCI was associated with low rates of distal embolization and 30-day MACE.

KW - Angioplasty

KW - Distal protection

KW - Myocardial infarction

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