Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0‐1 coronary flow: Insights from an all comers registry
Objectives To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST‐elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0‐1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR)...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2017-10, Vol.90 (4), p.531-539 |
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| creator | Luz, André Silveira, Inês Brochado, Bruno Rodrigues, Patrícia João Sousa, Maria Santos, Raquel Trêpa, Maria Santos, Mário Silveira, João Torres, Severo Leite‐Moreira, Adelino F. Carvalho, Henrique |
| description | Objectives
To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST‐elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0‐1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in‐hospital clinical events, emphasizing neurological outcomes.
Background
The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality.
Results
In 850 consecutive STEMI‐patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2‐3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P‐interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln‐transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR |
| doi_str_mv | 10.1002/ccd.26959 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1867984398</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1867984398</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-bc7b4736fc3021102c566e5d8245d975c50ee2215bcb545b37da325f5dbd63003</originalsourceid><addsrcrecordid>eNp10c9uFCEcB3BiNLZWD76AIfGih235MzCDt2b9t0kbLzXxRhgGulQGVmCymZuP4Iv4Uj6JbGf1YOIJEj5884MvAM8xOscIkQuth3PCBRMPwClmhKxawr88PO6xaPgJeJLzHUJIcCIegxPSYYHbhp6Cn9cqTMrDsk1x7I0ucZyhsdZpZ4KeoQswGa-KiyFv3Q6WWKmBKhkFVYHJ5a8Hs6vChJLh3pUtHOeoVRpczXXBqqQP15ejm831BqJf339gqGOKQaUZWh_3b-AmZHe7rRG2TgJVgMr7akaTch3h1uWS5qfgkVU-m2fH9Qx8fv_uZv1xdfXpw2Z9ebXSlFGx6nXbNy3lVlNEMEZEM84NGzrSsEG0TDNkDCGY9bpnDetpOyhKmGVDP3CKED0Dr5bcXYrfJpOLHF3WxnsVTJyyxB1vRddQ0VX68h96F6cU6nSy_nxHG4zu1etF6RRzTsbKXXJjfbzESB46lLVDed9htS-OiVM_muGv_FNaBRcL2Dtv5v8nyfX67RL5G296qHI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1948341098</pqid></control><display><type>article</type><title>Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0‐1 coronary flow: Insights from an all comers registry</title><source>Wiley-Blackwell Journals</source><source>MEDLINE</source><creator>Luz, André ; Silveira, Inês ; Brochado, Bruno ; Rodrigues, Patrícia ; João Sousa, Maria ; Santos, Raquel ; Trêpa, Maria ; Santos, Mário ; Silveira, João ; Torres, Severo ; Leite‐Moreira, Adelino F. ; Carvalho, Henrique</creator><creatorcontrib>Luz, André ; Silveira, Inês ; Brochado, Bruno ; Rodrigues, Patrícia ; João Sousa, Maria ; Santos, Raquel ; Trêpa, Maria ; Santos, Mário ; Silveira, João ; Torres, Severo ; Leite‐Moreira, Adelino F. ; Carvalho, Henrique</creatorcontrib><description>Objectives
To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST‐elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0‐1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in‐hospital clinical events, emphasizing neurological outcomes.
Background
The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality.
Results
In 850 consecutive STEMI‐patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2‐3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P‐interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln‐transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR <28%. Clinical outcomes including stroke between MT and PCI‐only groups were not different.
Conclusion
In comparison with the group where MT was inefficient, efficient MT may modestly reduce final infarct size without a significant clinical benefit. In comparison with PCI‐only, no difference was found regarding stroke. © 2017 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.26959</identifier><identifier>PMID: 28191743</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Blood clots ; Cerebral infarction ; Clinical trials ; Coronary Angiography ; Coronary Circulation ; Embolization ; Female ; Heart attacks ; Hospital Mortality ; Humans ; Male ; manual thrombectomy, area at risk ; Middle Aged ; Myocardial infarction ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Registries ; Retrospective Studies ; Risk Factors ; ST Elevation Myocardial Infarction - diagnostic imaging ; ST Elevation Myocardial Infarction - mortality ; ST Elevation Myocardial Infarction - physiopathology ; ST Elevation Myocardial Infarction - therapy ; Stroke ; Stroke - etiology ; ST‐elevation myocardial infarction ; Thrombectomy - adverse effects ; Thrombectomy - methods ; Thrombectomy - mortality ; Thrombosis ; Time Factors ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>Catheterization and cardiovascular interventions, 2017-10, Vol.90 (4), p.531-539</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-bc7b4736fc3021102c566e5d8245d975c50ee2215bcb545b37da325f5dbd63003</citedby><cites>FETCH-LOGICAL-c3539-bc7b4736fc3021102c566e5d8245d975c50ee2215bcb545b37da325f5dbd63003</cites><orcidid>0000-0003-0107-5023</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.26959$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.26959$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28191743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luz, André</creatorcontrib><creatorcontrib>Silveira, Inês</creatorcontrib><creatorcontrib>Brochado, Bruno</creatorcontrib><creatorcontrib>Rodrigues, Patrícia</creatorcontrib><creatorcontrib>João Sousa, Maria</creatorcontrib><creatorcontrib>Santos, Raquel</creatorcontrib><creatorcontrib>Trêpa, Maria</creatorcontrib><creatorcontrib>Santos, Mário</creatorcontrib><creatorcontrib>Silveira, João</creatorcontrib><creatorcontrib>Torres, Severo</creatorcontrib><creatorcontrib>Leite‐Moreira, Adelino F.</creatorcontrib><creatorcontrib>Carvalho, Henrique</creatorcontrib><title>Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0‐1 coronary flow: Insights from an all comers registry</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objectives
To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST‐elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0‐1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in‐hospital clinical events, emphasizing neurological outcomes.
Background
The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality.
Results
In 850 consecutive STEMI‐patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2‐3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P‐interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln‐transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR <28%. Clinical outcomes including stroke between MT and PCI‐only groups were not different.
Conclusion
In comparison with the group where MT was inefficient, efficient MT may modestly reduce final infarct size without a significant clinical benefit. In comparison with PCI‐only, no difference was found regarding stroke. © 2017 Wiley Periodicals, Inc.</description><subject>Aged</subject><subject>Blood clots</subject><subject>Cerebral infarction</subject><subject>Clinical trials</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation</subject><subject>Embolization</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>manual thrombectomy, area at risk</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>ST Elevation Myocardial Infarction - diagnostic imaging</subject><subject>ST Elevation Myocardial Infarction - mortality</subject><subject>ST Elevation Myocardial Infarction - physiopathology</subject><subject>ST Elevation Myocardial Infarction - therapy</subject><subject>Stroke</subject><subject>Stroke - etiology</subject><subject>ST‐elevation myocardial infarction</subject><subject>Thrombectomy - adverse effects</subject><subject>Thrombectomy - methods</subject><subject>Thrombectomy - mortality</subject><subject>Thrombosis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10c9uFCEcB3BiNLZWD76AIfGih235MzCDt2b9t0kbLzXxRhgGulQGVmCymZuP4Iv4Uj6JbGf1YOIJEj5884MvAM8xOscIkQuth3PCBRMPwClmhKxawr88PO6xaPgJeJLzHUJIcCIegxPSYYHbhp6Cn9cqTMrDsk1x7I0ucZyhsdZpZ4KeoQswGa-KiyFv3Q6WWKmBKhkFVYHJ5a8Hs6vChJLh3pUtHOeoVRpczXXBqqQP15ejm831BqJf339gqGOKQaUZWh_3b-AmZHe7rRG2TgJVgMr7akaTch3h1uWS5qfgkVU-m2fH9Qx8fv_uZv1xdfXpw2Z9ebXSlFGx6nXbNy3lVlNEMEZEM84NGzrSsEG0TDNkDCGY9bpnDetpOyhKmGVDP3CKED0Dr5bcXYrfJpOLHF3WxnsVTJyyxB1vRddQ0VX68h96F6cU6nSy_nxHG4zu1etF6RRzTsbKXXJjfbzESB46lLVDed9htS-OiVM_muGv_FNaBRcL2Dtv5v8nyfX67RL5G296qHI</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Luz, André</creator><creator>Silveira, Inês</creator><creator>Brochado, Bruno</creator><creator>Rodrigues, Patrícia</creator><creator>João Sousa, Maria</creator><creator>Santos, Raquel</creator><creator>Trêpa, Maria</creator><creator>Santos, Mário</creator><creator>Silveira, João</creator><creator>Torres, Severo</creator><creator>Leite‐Moreira, Adelino F.</creator><creator>Carvalho, Henrique</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0107-5023</orcidid></search><sort><creationdate>20171001</creationdate><title>Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0‐1 coronary flow: Insights from an all comers registry</title><author>Luz, André ; Silveira, Inês ; Brochado, Bruno ; Rodrigues, Patrícia ; João Sousa, Maria ; Santos, Raquel ; Trêpa, Maria ; Santos, Mário ; Silveira, João ; Torres, Severo ; Leite‐Moreira, Adelino F. ; Carvalho, Henrique</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-bc7b4736fc3021102c566e5d8245d975c50ee2215bcb545b37da325f5dbd63003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Blood clots</topic><topic>Cerebral infarction</topic><topic>Clinical trials</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation</topic><topic>Embolization</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>manual thrombectomy, area at risk</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>ST Elevation Myocardial Infarction - diagnostic imaging</topic><topic>ST Elevation Myocardial Infarction - mortality</topic><topic>ST Elevation Myocardial Infarction - physiopathology</topic><topic>ST Elevation Myocardial Infarction - therapy</topic><topic>Stroke</topic><topic>Stroke - etiology</topic><topic>ST‐elevation myocardial infarction</topic><topic>Thrombectomy - adverse effects</topic><topic>Thrombectomy - methods</topic><topic>Thrombectomy - mortality</topic><topic>Thrombosis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luz, André</creatorcontrib><creatorcontrib>Silveira, Inês</creatorcontrib><creatorcontrib>Brochado, Bruno</creatorcontrib><creatorcontrib>Rodrigues, Patrícia</creatorcontrib><creatorcontrib>João Sousa, Maria</creatorcontrib><creatorcontrib>Santos, Raquel</creatorcontrib><creatorcontrib>Trêpa, Maria</creatorcontrib><creatorcontrib>Santos, Mário</creatorcontrib><creatorcontrib>Silveira, João</creatorcontrib><creatorcontrib>Torres, Severo</creatorcontrib><creatorcontrib>Leite‐Moreira, Adelino F.</creatorcontrib><creatorcontrib>Carvalho, Henrique</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luz, André</au><au>Silveira, Inês</au><au>Brochado, Bruno</au><au>Rodrigues, Patrícia</au><au>João Sousa, Maria</au><au>Santos, Raquel</au><au>Trêpa, Maria</au><au>Santos, Mário</au><au>Silveira, João</au><au>Torres, Severo</au><au>Leite‐Moreira, Adelino F.</au><au>Carvalho, Henrique</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0‐1 coronary flow: Insights from an all comers registry</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>90</volume><issue>4</issue><spage>531</spage><epage>539</epage><pages>531-539</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives
To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST‐elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0‐1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in‐hospital clinical events, emphasizing neurological outcomes.
Background
The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality.
Results
In 850 consecutive STEMI‐patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2‐3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P‐interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln‐transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR <28%. Clinical outcomes including stroke between MT and PCI‐only groups were not different.
Conclusion
In comparison with the group where MT was inefficient, efficient MT may modestly reduce final infarct size without a significant clinical benefit. In comparison with PCI‐only, no difference was found regarding stroke. © 2017 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28191743</pmid><doi>10.1002/ccd.26959</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0107-5023</orcidid></addata></record> |
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| ispartof | Catheterization and cardiovascular interventions, 2017-10, Vol.90 (4), p.531-539 |
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| source | Wiley-Blackwell Journals; MEDLINE |
| subjects | Aged Blood clots Cerebral infarction Clinical trials Coronary Angiography Coronary Circulation Embolization Female Heart attacks Hospital Mortality Humans Male manual thrombectomy, area at risk Middle Aged Myocardial infarction Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Registries Retrospective Studies Risk Factors ST Elevation Myocardial Infarction - diagnostic imaging ST Elevation Myocardial Infarction - mortality ST Elevation Myocardial Infarction - physiopathology ST Elevation Myocardial Infarction - therapy Stroke Stroke - etiology ST‐elevation myocardial infarction Thrombectomy - adverse effects Thrombectomy - methods Thrombectomy - mortality Thrombosis Time Factors Treatment Outcome Ventricular Function, Left |
| title | Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0‐1 coronary flow: Insights from an all comers registry |
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