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Background Routine thrombus aspiration in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) does not improve clinical outcomes. However, there is remaining uncertainty about the potential benefit in those patients with high thrombus burden, where there is a biological rationale for greater benefit. Objectives The purpose of this study was to evaluate the benefit of thrombus aspiration among STEMI patients with high thrombus burden. Methods TOTAL (ThrOmbecTomy with PCI vs. PCI ALone in patients with STEMI) was a randomized trial of routine manual thrombectomy versus PCI alone in patients with STEMI (n = 10,732). High thrombus burden (Thrombolysis In Myocardial Infarction thrombus grade ≥3) was a pre-specified subgroup. Results The primary outcome of cardiovascular (CV) death, MI, cardiogenic shock, or heart failure was not different at 1 year with thrombus aspiration in patients with high thrombus burden (8.1% vs. 8.3% thrombus aspiration; hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.84 to 1.13) or low thrombus burden (6.0% vs. 5.0% thrombus aspiration; HR: 1.22; 95% CI: 0.73 to 2.05; interaction p = 0.41). However, among patients with high thrombus burden, stroke at 30 days was more frequent with thrombus aspiration (31 [0.7%] thrombus aspiration vs. 16 [0.4%] PCI alone, HR: 1.90; 95% CI: 1.04 to 3.48). In the high thrombus burden group, thrombus aspiration did not significantly improve CV mortality at 30 days (HR: 0.78; 95% CI: 0.61 to 1.01; p = 0.06) and at 1 year (HR: 0.88; 95% CI: 0.72 to 1.09; p = 0.25). Irrespective of treatment assignment, high thrombus burden was an independent predictor of death (HR: 1.78; 95% CI: 1.05 to 3.01). Conclusions In patients with high thrombus burden, routine thrombus aspiration did not improve outcomes at 1 year and was associated with an increased rate of stroke. High thrombus burden is still an important predictor of outcome in STEMI. (A Trial of routine aspiration ThrOmbecTomy with PCI vs. PCI ALone in patients with STEMI [TOTAL]; NCT01149044)

Ticagrelor has shown superiority compared with clopidogrel in reducing cardiovascular events [(1)][1]. Although some of the clinical benefits of ticagrelor may simply reflect its potency in inhibiting platelet aggregation, the action of this drug on blood vessels may also play a role. Ticagrelor

Radial artery occlusion is the most common complication following trans-radial approach (TRA) for cardiac catheterization. Our aim was to compare short durations of compression hemostatic device (CHD) application post TRA in patients not receiving anticoagulation. Patients (n=450) undergoing

The StatSeal (Biolife, Sarasota, FL, USA) is a hemostasis adjunct disc utilized in conjunction with a radial hemostatic band to reduce bleeding. We aimed to assess the safety and efficacy of using the StatSeal disc in patients undergoing coronary angiography through the radial approach without

This study sought to determine the incidence, predictors, and prognostic value of heart failure (HF) during and after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. The TOTAL trial was an international randomized trial (N = 10,732) comparing thrombus

Radiation exposure to patients and operators during cardiac catheterization may be hazardous. We evaluated whether the use of a novel lead-based arm-board reduces radiation exposure to the operator compared to usual practice, and if it affects patient exposure. We performed a single center

Recent studies indicate that aggressive hypothermia for out-of-hospital cardiac arrest (OHCA) may be unnecessary. This has raised skepticism regarding the utility of hypothermia for OHCA. The aim of this meta-analysis was to determine whether hypothermia improves clinically-relevant outcomes

Contrast-induced nephropathy (CIN) is an important cause of iatrogenic morbidity and mortality. The amount of contrast delivered is dependent on the complexity of the procedure and operator technique, and has a major impact on the incidence of CIN. It is unclear whether the use of automatic systems

• By improving venous return, gekoTM has the potential to have a therapeutic effect in the management of coronary artery disease by augmenting coronary blood flow Background: Improving myocardial blood supply in patients with coronary artery disease (CAD) may improve angina. The gekoTM device is a small transcutaneous nerve stimulator that is applied non-invasively to the skin over the common peroneal nerve and stimulates peripheral blood flow. The purpose of this study was to investigate the effect of the gekoTM device on coronary blood flow.

Trans-radial access (TRA) for invasive coronary assessment and percutaneous coronary intervention (PCI) has evolved as an alternative default strategy for vascular access to the femoral approach, and in many centers is used more frequently than femoral access. One of the barriers to more widespread

There remains controversy whether earlier initiation of hypothermia for patients with cardiac arrest improves outcomes. The aim of this study was to determine whether hypothermia initiated in the field (pre-hospital) improves clinically relevant outcomes compared with hypothermia initiated after