Proximal embolic protection in patients undergoing primary angioplasty for acute myocardial infarction (PREPARE): core lab adjudicated angiographic outcomes of a randomised controlled trial

Background Patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) with the Proms system (St Jude Medical, St Paul, MN, USA) achieved significantly better microvascular flow as measured by ST-segment resolution However, no differences were observed in left ventricular ejection fraction or infarct size as obtained by cardiovascular magnetic resonance imaging The goal of the present study was to evaluate the effect of combined proximal embolic protection and thrombus aspiration on core lab adjudicated angiographic outcomes

Methods In the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST Elevation (PREPARE) study, patients were randomised to primary PCI with the Proms system (n=141) or primary PCI alone (n=143) An independent core laboratory re-evaluated all angiograms and adjudicated the angiographic outcomes and computerised quantitative blush evaluation (QuBE) value

Results There were no significant differences in Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade, or angiographic signs of distal embolisation among the two arms QuBE values did not significantly differ between the Proxis-treated patients and control patients (15 1 +/- 5 4 vs 15 8 +/- 5 5, respectively, p=0 34)

Conclusion Primary PCI with combined proximal embolic protection and thrombus aspiration in STEMI patients more frequently resulted in complete immediate ST resolution compared with control patients However, there were no significant differences in core laboratory adjudicated angiographic outcomes (Neth Heart J 2010,18 531-6)