March 2, 2005

Distal Embolic Protection in Patients With Acute Myocardial InfarctionAttractive Concept But No Evidence of Benefit

Author Affiliations

Author Affiliation: Deutsches Herzzentrum and 1 Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany.

JAMA. 2005;293(9):1116-1118. doi:10.1001/jama.293.9.1116

The goal of reperfusion therapy in acute myocardial infarction (AMI) is not only the early, full, and sustained restoration of antegrade flow at the epicardial level but also the achievement of adequate reperfusion at the myocardial level.1 Failure to achieve myocardial reperfusion despite the presence of a patent coronary artery has been termed the “no-reflow” phenomenon and attributed to microvascular dysfunction.2 Diagnostic techniques such as ST-segment resolution, angiographic blush, nuclear scintigraphy, myocardial contrast echocardiography, coronary Doppler, magnetic resonance imaging, and positron emission tomography have been used to assess the “no-reflow” phenomenon.2,3 The presence of no reflow in patients with AMI receiving reperfusion therapies has been associated with poor outcomes.4

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