PMID- 30261959
OWN - NLM
STAT- MEDLINE
DCOM- 20190910
LR  - 20190910
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 72
IP  - 14
DP  - 2018 Oct 2
TI  - Thrombus Aspiration in Patients With High Thrombus Burden in the TOTAL Trial.
PG  - 1589-1596
LID - S0735-1097(18)35751-6 [pii]
LID - 10.1016/j.jacc.2018.07.047 [doi]
AB  - 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).
CI  - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Jolly, Sanjit S
AU  - Jolly SS
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada. Electronic address: sanjit.jolly@phri.ca.
FAU - Cairns, John A
AU  - Cairns JA
AD  - Department of Medicine, Division of Cardiology, University of British Columbia, 
      Vancouver, British Columbia, Canada.
FAU - Lavi, Shahar
AU  - Lavi S
AD  - Department of Medicine, Division of Cardiology, Western University, London Health 
      Sciences Centre, London, Ontario, Canada.
FAU - Cantor, Warren J
AU  - Cantor WJ
AD  - Department of Medicine, Division of Cardiology, Southlake Regional Health Center, 
      University of Toronto, Toronto, Ontario, Canada.
FAU - Bernat, Ivo
AU  - Bernat I
AD  - University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
FAU - Cheema, Asim N
AU  - Cheema AN
AD  - Department of Medicine, Division of Cardiology, St. Michael's Hospital, 
      University of Toronto, Toronto, Ontario, Canada.
FAU - Moreno, Raul
AU  - Moreno R
AD  - Department of Medicine, Division of Cardiology, University Hospital La Paz, 
      Madrid, Spain.
FAU - Kedev, Sasko
AU  - Kedev S
AD  - University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, 
      Macedonia.
FAU - Stankovic, Goran
AU  - Stankovic G
AD  - Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University 
      of Belgrade, Belgrade, Serbia.
FAU - Rao, Sunil V
AU  - Rao SV
AD  - Duke Clinical Research Institute, Durham, North Carolina.
FAU - Meeks, Brandi
AU  - Meeks B
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Chowdhary, Saqib
AU  - Chowdhary S
AD  - Department of Medicine, Division of Cardiology, University Hospitals South 
      Manchester, Manchester Academic Health Science Centre, Manchester, United 
      Kingdom.
FAU - Gao, Peggy
AU  - Gao P
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Sibbald, Matthew
AU  - Sibbald M
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Velianou, James L
AU  - Velianou JL
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Mehta, Shamir R
AU  - Mehta SR
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Tsang, Michael
AU  - Tsang M
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Sheth, Tej
AU  - Sheth T
AD  - Department of Medicine, Division of Cardiology, McMaster University and 
      Population Health Research Institute, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Dzavik, Vladimir
AU  - Dzavik V
AD  - Department of Medicine, Division of Cardiology, Peter Munk Cardiac Centre, 
      University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
CN  - TOTAL Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT01149044
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2018 Oct 2;72(14):1597-1599. PMID: 30261960
CIN - J Am Coll Cardiol. 2019 Feb 5;73(4):530-531. PMID: 30704588
CIN - J Am Coll Cardiol. 2019 Feb 5;73(4):532. PMID: 30704590
MH  - Coronary Thrombosis/epidemiology/*therapy
MH  - Female
MH  - Heart Failure/epidemiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Percutaneous Coronary Intervention
MH  - Recurrence
MH  - ST Elevation Myocardial Infarction/epidemiology/*therapy
MH  - Shock, Cardiogenic/epidemiology
MH  - Stroke/epidemiology
MH  - *Thrombectomy
OTO - NOTNLM
OT  - PCI
OT  - STEMI
OT  - thrombectomy
EDAT- 2018/09/29 06:00
MHDA- 2019/09/11 06:00
CRDT- 2018/09/29 06:00
PHST- 2018/04/16 00:00 [received]
PHST- 2018/06/29 00:00 [revised]
PHST- 2018/07/02 00:00 [accepted]
PHST- 2018/09/29 06:00 [entrez]
PHST- 2018/09/29 06:00 [pubmed]
PHST- 2019/09/11 06:00 [medline]
AID - S0735-1097(18)35751-6 [pii]
AID - 10.1016/j.jacc.2018.07.047 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2018 Oct 2;72(14):1589-1596. doi: 10.1016/j.jacc.2018.07.047.