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Randomized Controlled Trial
. 2008 Jun;155(6):1090-6.
doi: 10.1016/j.ahj.2007.12.003. Epub 2008 Jan 30.

Contemporary outcomes of rescue percutaneous coronary intervention for acute myocardial infarction: comparison with primary angioplasty and the role of distal protection devices (EMERALD trial)

George Dangas  1 , Gregg W Stone, Mitchell D Weinberg, John Webb, David A Cox, Bruce R Brodie, Mitchell W Krucoff, Raymond J Gibbons, Alexandra J Lansky, Roxana Mehran; EMERALD Investigators
Affiliations
Randomized Controlled Trial

Contemporary outcomes of rescue percutaneous coronary intervention for acute myocardial infarction: comparison with primary angioplasty and the role of distal protection devices (EMERALD trial)

George Dangas et al. Am Heart J. 2008 Jun.

Abstract

Background: The value of distal protection devices during rescue PCI has not been studied.

Methods: The population enrolled in a prospective, randomized multicenter trial of distal microcirculatory protection in ST-elevation MI, was stratified for those undergoing rescue (n = 93) or primary (n = 408) PCI; we performed the prespecified comparisons of distal protection in rescue and primary PCI.

Results: Compared to primary PCI, rescue patients had higher baseline rates of TIMI-3 flow, but lower rates of post PCI TIMI-3 flow. However, no differences in the primary endpoints of complete ST-segment resolution (STR) at 30 minutes or infarct size, or 6 month mortality were present. In rescue PCI patients, randomization to distal protection did not significantly affect infarct size, STR, mortality or other clinical events.

Conclusion: Despite reduced rates of post-procedural TIMI-3 flow, patients undergoing rescue PCI compared to primary PCI have similar myocardial perfusion, infarct size and clinical outcomes. Distal protection did not offer any detectable benefit in this patient population.

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