Back to Search
Start Over
Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial
- Publication Year :
- 2016
- Publisher :
- Oxford University Press, 2016.
-
Abstract
- Aims Thrombectomy during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) has been thought to be an effective therapy to prevent distal embolization and improve microvascular perfusion. The TOTAL trial ( N = 10 732), a randomized trial of routine manual thrombectomy vs. PCI alone in STEMI, showed no difference in the primary efficacy outcome. This angiographic sub-study was performed to determine if thrombectomy improved microvascular perfusion as measured by myocardial blush grade (MBG). Methods and results Of the 10 732 patients randomized, 1610 randomly selected angiograms were analysable by the angiographic core laboratory. Primary outcomes included MBG and post-PCI thrombolysis in myocardial infarction (TIMI) flow grade. Secondary outcomes included distal embolization, PPCI complications, and each component of the complications. The primary end point of final myocardial blush (221 [28%] 0/1 for thrombectomy vs. 246 {30%} 0/1 for PCI alone group, P = 0.38) and TIMI flow (712 [90%] TIMI 3 for thrombectomy vs. 733 [89.5%] TIMI 3 for PCI alone arm, P = 0.73) was similar in the two groups. Thrombectomy was associated with a significantly reduced incidence of distal embolization compared with PCI alone (56 [7.1%] vs. 87 [10.7%], P = 0.01). In multivariable analysis, distal embolization was an independent predictor of mortality (HR 3.00, 95% CI 1.19–7.58) while MBG was not (HR 2.73, 95% CI 0.94–5.3). Conclusions Routine thrombectomy during PPCI did not result in improved MBG or post-PCI TIMI flow grade but did reduce distal embolization compared with PCI alone. Distal embolization and not blush grade is independently associated with mortality.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
030204 cardiovascular system & hematology
Coronary Angiography
law.invention
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Randomized controlled trial
St elevation myocardial infarction
law
Internal medicine
medicine
Clinical endpoint
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Angioplasty, Balloon, Coronary
FASTTrack Clinical Research
Thrombectomy
business.industry
Coronary Thrombosis
Percutaneous coronary intervention
Thrombolysis
medicine.disease
3. Good health
Surgery
surgical procedures, operative
Treatment Outcome
Conventional PCI
Cardiology
ST Elevation Myocardial Infarction
Cardiology and Cardiovascular Medicine
business
TIMI
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....91558ac69f185255d2bda7dd702356a3