PMID- 27125948
OWN - NLM
STAT- MEDLINE
DCOM- 20180410
LR  - 20240325
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 37
IP  - 24
DP  - 2016 Jun 21
TI  - Myocardial blush and microvascular reperfusion following manual thrombectomy 
      during percutaneous coronary intervention for ST elevation myocardial infarction: 
      insights from the TOTAL trial.
PG  - 1891-8
LID - 10.1093/eurheartj/ehw157 [doi]
AB  - 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.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author 2016. For permissions please email: journals.permissions@oup.com.
FAU - Sharma, Vinoda
AU  - Sharma V
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Jolly, Sanjit S
AU  - Jolly SS
AD  - The Population Health Research Institute, Hamilton Health Sciences, McMaster 
      University, Hamilton General Hospital, Hamilton, ON, Canada.
FAU - Hamid, Tahir
AU  - Hamid T
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Sharma, Divyesh
AU  - Sharma D
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Chiha, Joseph
AU  - Chiha J
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Chan, William
AU  - Chan W
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Fuchs, Felipe
AU  - Fuchs F
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Bui, Sanh
AU  - Bui S
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Gao, Peggy
AU  - Gao P
AD  - The Population Health Research Institute, Hamilton Health Sciences, McMaster 
      University, Hamilton General Hospital, Hamilton, ON, Canada.
FAU - Kassam, Saleem
AU  - Kassam S
AD  - Rouge Valley Health System, Toronto, ON, Canada.
FAU - Leung, Raymond C M
AU  - Leung RC
AD  - CK Hui Heart Centre, Edmonton, AB, Canada.
FAU - Horak, David
AU  - Horak D
AD  - KrajskaNemocnice Liberec, Liberec, Czech Republic.
FAU - Romppanen, Hannu O
AU  - Romppanen HO
AD  - Heart Centre, Kuopio University Hospital, Kuopio, Finland.
FAU - El-Omar, Magdi
AU  - El-Omar M
AD  - Central Manchester Foundation Trust, Manchester Academic Health Science Centre, 
      Manchester, UK.
FAU - Chowdhary, Saqib
AU  - Chowdhary S
AD  - Central Manchester Foundation Trust, Manchester Academic Health Science Centre, 
      Manchester, UK.
FAU - Stankovic, Goran
AU  - Stankovic G
AD  - Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University 
      of Belgrade, Belgrade, Serbia.
FAU - Kedev, Sasko
AU  - Kedev S
AD  - University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, 
      Macedonia.
FAU - Rokoss, Michael J
AU  - Rokoss MJ
AD  - The Population Health Research Institute, Hamilton Health Sciences, McMaster 
      University, Hamilton General Hospital, Hamilton, ON, Canada.
FAU - Sheth, Tej
AU  - Sheth T
AD  - The Population Health Research Institute, Hamilton Health Sciences, McMaster 
      University, Hamilton General Hospital, Hamilton, ON, Canada.
FAU - Dzavik, Vladimir
AU  - Dzavik V
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4.
FAU - Overgaard, Christopher B
AU  - Overgaard CB
AD  - Peter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, 
      Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 
      Elizabeth Street, Toronto, ON Canada M5G 2C4 chris.overgaard1@gmail.com.
LA  - eng
GR  - CIHR/Canada
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20160428
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
CIN - Eur Heart J. 2016 Jun 21;37(24):1899-901. PMID: 27247362
MH  - Angioplasty, Balloon, Coronary
MH  - Coronary Angiography
MH  - Humans
MH  - Myocardial Infarction
MH  - Percutaneous Coronary Intervention
MH  - *ST Elevation Myocardial Infarction
MH  - *Thrombectomy
MH  - Treatment Outcome
PMC - PMC4917747
OTO - NOTNLM
OT  - *Myocardial Blush Grade
OT  - *STEMI
OT  - *Thrombectomy
EDAT- 2016/04/30 06:00
MHDA- 2018/04/11 06:00
PMCR- 2017/06/21
CRDT- 2016/04/30 06:00
PHST- 2015/11/30 00:00 [received]
PHST- 2016/03/22 00:00 [accepted]
PHST- 2016/04/30 06:00 [entrez]
PHST- 2016/04/30 06:00 [pubmed]
PHST- 2018/04/11 06:00 [medline]
PHST- 2017/06/21 00:00 [pmc-release]
AID - ehw157 [pii]
AID - 10.1093/eurheartj/ehw157 [doi]
PST - ppublish
SO  - Eur Heart J. 2016 Jun 21;37(24):1891-8. doi: 10.1093/eurheartj/ehw157. Epub 2016 
      Apr 28.