Original title: Mesh-Covered Embolic Protection Stent Implantation in ST-Segment–Elevation Myocardial Infarction. Final 1-Year Clinical and Angiographic Results From the MGUARD for Acute ST Elevation Reperfusion Trial. Reference: DariuszDudek et al. CircCardiovascInterv. 2015 Feb;8(2).
The MGuard is a micronet mesh-covered stent designed to reduce distal embolization in the context of ST elevation myocardial infarction. In the MASTER study (MGUARD forAcute ST ElevationReperfusion) the primary end point of STEMI resolution was significantly superior with MGuard. This study assesses clinical and angiographic 1 year outcomes.
432 STEMI patients receiving PCI were included and randomized to MGuard stent vs. any other metal stent available (39.8% were drug eluting stents).Clinical follow-up was performed through 1 year, and angiography at 13 months was done in 50 MGuard patients.
There were no differences in major adverse cardiac events at 30 days between both groups (1.8% vs 2.3%; p=0.75) but at 12 months a higher rate of events was observed in the MGuard group, mainly due to a higher rate of ischemia driven target lesion revascularization (8.6% vs 0.9%; p=0.0003).
Despite the latter, mortality showed a tendency in favor of the MGuard both at 30 days (0% vs 1.9%; p=0.04) and at 1 year (1.0% vs 3.3%; p=0.09). Angiographic follow up of MGuardpatients showed a 31.6% binary restenosis.
Conclusion
In patients undergoing ST elevation myocardial infarction receiving primary PCI, a tendency towards reduced mortality was observed in those receiving the micronet mesh covered stent MGuard. The higher revascularization rates of target lesion and binary restenosis were consistent with those of conventional stents.
Editorial Comment
The primary end point of this study was STEMI resolution; this is why it is underpowered to draw definite conclusions regarding clinical outcomes, let alone mortality (in fact, mortality was only a tendency). All the same, the physiopathological concept is reasonable and outcomes seem better in acute STEMI as regards TIMI flow, even at the cost of more subsequent revascularization.
SOLACI