Study Of A Distal Protection Device During Primary Angioplasty In Acute Myocardial Infarction

Objective: To evaluate the safety and efficacy of the GuardWire Plus^TM during high risk PCI in the patients with acute myocardial infarction(AMI).Methods: 72 patients with AMIwere underwent PCI with the GuardWire Plus^TM distal protection device (GW group) or a conventional guidewire (NGWgroup) from September, 2004 to December, 2006。The GW group included 38 patients and the NGW group included 34 patients。The basic clinical characteristics, angiographic results, ST resolution, TIMI flow grade,TIMI frame count and myocardial blush were compared。LVEF was measured by echocardiography at discharge and were performed 3 months after percutaneous coronary intervention。CK-MB and CTNI levels in patients were measured before operation and the 6h,8h,10h,12h,16h,24hthe second day,third day,fifth day after onset. The plasma ET,PRA,ALD,AngⅡ, NE and E levels in patients were measured on the day of operation and the first day,second day,third day,fifth day after onset.Results: In the GW group, protection device assisted angioplasty with stent implantation was successful and received in all patients。Post procedural ST-segment resolution=50% was found in a significantly higher percentage of patients in the GW group (68.4%vs41.2%, p＜0.05)。Post procedural the TIMI flow was not significantly different,TIMI frame count (p=0.043) and myocardial blush (p=0.000) were significantly different。Left ventricular ejection fraction at discharge was significantly greater in the GW group than that in the NGW group。The serum level of CK-MB of GW group reached peak at 8.63±2.42 h after onset, while that of NGW group reached peak at2.35±2.06 h after onset. The serum peak level of CK-MB were also significantly lower in GW group than that in NGW group (63.3±9.82vs74.28±6.15, p=0.000)。The serum level of CTNI of GW group reached peak at 10.16±2.96 h after PCI, while that of NGW group reached peak at 12.35±2.06 h after onset. The serum peak level of CTNI were also significantly lower in GW group than that in NGW group (18.01±7.21vs21.48±5.61, p=0.027)。Theneuroendocrine factors declined rapidly after PCI according to the curve. ET,PRA,AngⅡ,ALD,NE and E of A group were significantly lower than B group(P＜0.05) at the first or second day after onset.Conclusions :This preliminary study demonstrates the feasibility and safety of using the GuardWire Plus^TM distal protection device during PCI in AMI patients to prevent distal embolizationl, decrease the infarction size and increase LVEF。Postgraduate student: Ying-jie YaoDirected by Prof: Xu Wang...