Author + information
- Received September 28, 2007
- Revision received March 3, 2008
- Accepted March 15, 2008
- Published online June 1, 2008.
- Atsunori Okamura, MD,
- Hiroshi Ito, MD, FACC⁎ (, )
- Katsuomi Iwakura, MD,
- Toshiya Kurotobi, MD,
- Yasushi Koyama, MD,
- Motoo Date, MD,
- Yoshiharu Higuchi, MD,
- Koichi Inoue, MD and
- Kenshi Fujii, MD
- ↵⁎Reprint requests and correspondence:
Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
Objectives This study sought to investigate the timing and amount of embolic particles generation during the percutaneous coronary intervention (PCI) procedure and studied the relationship between embolic burden and coronary blood flow and myocardial damage.
Background Distal embolization is a major complication of PCI. The Doppler guidewire (DGW) can detect the embolic particles as high-intensity transient signals (HITS) during the PCI procedure.
Methods We prospectively studied 37 patients with acute myocardial infarction (MI). Under monitoring with the DGW, we performed first and second balloon angioplasty, followed by stenting and post-high-pressure dilatation. Left ventricular ejection fraction (LVEF) (%) and regional wall motion (RWM) (standard deviation/chord) were measured on days 1 and 22.
Results The HITS were detected in 35 of 37 patients. The number of HITS was the greatest after stenting (16 ± 18) followed by first balloon inflation (5 ± 4). There was a significant correlation between the total number of HITS and the corrected Thrombolysis In Myocardial Infarction frame count (r = 0.52, p = 0.003) and a significant weak inverse correlation between the total number of HITS and changes in LVEF and RWM (r = 0.37, p = 0.03 and r = 0.35, p = 0.04, respectively).
Conclusions Distal embolization is common during PCI in patients with acute MI, and the majority of HITS were observed after stenting. An increase in the total number of HITS is associated with reduced coronary blood flow, and is weakly associated with poor recovery of left ventricular function.
- Received September 28, 2007.
- Revision received March 3, 2008.
- Accepted March 15, 2008.
- American College of Cardiology Foundation