• Je něco špatně v tomto záznamu ?

Prognostic Role of Residual Thrombus Burden Following Thrombectomy: Insights From the TOTAL Trial

M. Alkhalil, M. Kuzemczak, R. Zhao, C. Kavvouras, WJ. Cantor, CB. Overgaard, S. Lavi, V. Sharma, S. Chowdhary, G. Stanković, S. Kedev, I. Bernat, R. Bhindi, T. Sheth, K. Niemela, SS. Jolly, V. Džavík

. 2022 ; 15 (5) : e011336. [pub] 20220517

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, randomizované kontrolované studie, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc22018530

Grantová podpora
CIHR - Canada

BACKGROUND: It is unclear whether more effective forms of thrombus removal than current aspiration catheters would lead to improved outcomes. We sought to evaluate the prognostic role of residual thrombus burden (rTB), after manual thrombectomy, in patients undergoing primary percutaneous coronary intervention with routine manual thrombectomy in the TOTAL trial (Thrombectomy Versus PCI Alone). METHODS: This is a single-arm analysis of patients from the TOTAL trial who underwent routine manual aspiration thrombectomy. The rTB was quantified by an angiographic core laboratory using the Thrombolysis in Myocardial Infarction criteria and validated using existing optical coherent tomography data. Large rTB was defined as grade ≥3. The primary outcome was death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening heart failure within 180 days. RESULTS: Of 5033 patients randomized to routine thrombectomy, 2869 patients had quantifiable rTB (1014 [35%] had large rTB). Patients with large rTB were more likely to have hypertension, previous percutaneous coronary intervention, myocardial infarction, or Killip class III on presentation but less likely to have Killip class I. The primary outcome occurred more frequently in patients with large rTB, even after adjustment for known risk predictors (8.6% versus 4.6%; adjusted hazard ratio, 1.83 [95% CI, 1.34-2.48]). These patients also had a higher risk of cardiovascular death (adjusted hazard ratio, 1.83 [95% CI, 1.13-2.95]), cardiogenic shock (adjusted hazard ratio, 2.02 [95% CI, 1.08-3.76]), and heart failure (adjusted hazard ratio, 1.74 [95% CI, 1.02-2.96]) but not myocardial infarction or stroke. CONCLUSIONS: Large rTB is a common finding in primary percutaneous coronary intervention and is associated with increased risk of adverse cardiovascular outcomes, including cardiovascular death. Future technologies offering better thrombus removal than current devices may decrease or even eliminate the risk associated with rTB. This, potentially, can turn into a strategic option to be studied in clinical trials. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01149044.

Citace poskytuje Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc22018530
003      
CZ-PrNML
005      
20220804134833.0
007      
ta
008      
220720s2022 xxu f 000 0|eng||
009      
AR
024    7_
$a 10.1161/CIRCINTERVENTIONS.121.011336 $2 doi
035    __
$a (PubMed)35580203
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a xxu
100    1_
$a Alkhalil, Mohammad $u Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.) $u Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom (M.A.) $u Translational and Clinical Research Institute, Newcastle University, United Kingdom (M.A.) $1 https://orcid.org/0000000230888878
245    10
$a Prognostic Role of Residual Thrombus Burden Following Thrombectomy: Insights From the TOTAL Trial / $c M. Alkhalil, M. Kuzemczak, R. Zhao, C. Kavvouras, WJ. Cantor, CB. Overgaard, S. Lavi, V. Sharma, S. Chowdhary, G. Stanković, S. Kedev, I. Bernat, R. Bhindi, T. Sheth, K. Niemela, SS. Jolly, V. Džavík
520    9_
$a BACKGROUND: It is unclear whether more effective forms of thrombus removal than current aspiration catheters would lead to improved outcomes. We sought to evaluate the prognostic role of residual thrombus burden (rTB), after manual thrombectomy, in patients undergoing primary percutaneous coronary intervention with routine manual thrombectomy in the TOTAL trial (Thrombectomy Versus PCI Alone). METHODS: This is a single-arm analysis of patients from the TOTAL trial who underwent routine manual aspiration thrombectomy. The rTB was quantified by an angiographic core laboratory using the Thrombolysis in Myocardial Infarction criteria and validated using existing optical coherent tomography data. Large rTB was defined as grade ≥3. The primary outcome was death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening heart failure within 180 days. RESULTS: Of 5033 patients randomized to routine thrombectomy, 2869 patients had quantifiable rTB (1014 [35%] had large rTB). Patients with large rTB were more likely to have hypertension, previous percutaneous coronary intervention, myocardial infarction, or Killip class III on presentation but less likely to have Killip class I. The primary outcome occurred more frequently in patients with large rTB, even after adjustment for known risk predictors (8.6% versus 4.6%; adjusted hazard ratio, 1.83 [95% CI, 1.34-2.48]). These patients also had a higher risk of cardiovascular death (adjusted hazard ratio, 1.83 [95% CI, 1.13-2.95]), cardiogenic shock (adjusted hazard ratio, 2.02 [95% CI, 1.08-3.76]), and heart failure (adjusted hazard ratio, 1.74 [95% CI, 1.02-2.96]) but not myocardial infarction or stroke. CONCLUSIONS: Large rTB is a common finding in primary percutaneous coronary intervention and is associated with increased risk of adverse cardiovascular outcomes, including cardiovascular death. Future technologies offering better thrombus removal than current devices may decrease or even eliminate the risk associated with rTB. This, potentially, can turn into a strategic option to be studied in clinical trials. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01149044.
650    12
$a koronární trombóza $x diagnostické zobrazování $x terapie $7 D003328
650    12
$a srdeční selhání $x diagnostické zobrazování $x terapie $7 D006333
650    _2
$a lidé $7 D006801
650    12
$a infarkt myokardu $x komplikace $x diagnostické zobrazování $x terapie $7 D009203
650    12
$a koronární angioplastika $7 D062645
650    _2
$a prognóza $7 D011379
650    _2
$a kardiogenní šok $x etiologie $x terapie $7 D012770
650    _2
$a trombektomie $x škodlivé účinky $x metody $7 D017131
650    _2
$a výsledek terapie $7 D016896
655    _2
$a časopisecké články $7 D016428
655    _2
$a randomizované kontrolované studie $7 D016449
655    _2
$a práce podpořená grantem $7 D013485
700    1_
$a Kuzemczak, Michał $u Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.) $u Division of Emergency Medicine, Poznan University of Medical Sciences, Poland (M.K.) $u Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland (M.K.) $1 https://orcid.org/000000030453642X
700    1_
$a Zhao, Robin $u Population Health Research Institute, McMaster University, Hamilton, Canada (R.Z., T.S., S.S.J.)
700    1_
$a Kavvouras, Charalampos $u Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.)
700    1_
$a Cantor, Warren J $u Division of Cardiology, University of Toronto and Southlake Regional Health Centre, Canada (W.J.C., C.B.O.)
700    1_
$a Overgaard, Christopher B $u Division of Cardiology, University of Toronto and Southlake Regional Health Centre, Canada (W.J.C., C.B.O.)
700    1_
$a Lavi, Shahar $u London Health Sciences Centre, Canada (S.L.)
700    1_
$a Sharma, Vinoda $u Cardiology Department, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (V.S.)
700    1_
$a Chowdhary, Saqib $u Cardiology Department, Wythenshawe Hospital, Manchester, United Kingdom (S.C.)
700    1_
$a Stanković, Goran $u Department of Cardiology, University of Belgrade, Serbia (G.S.) $1 https://orcid.org/0000000294140885
700    1_
$a Kedev, Saško $u University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Macedonia (S.K.)
700    1_
$a Bernat, Ivo $u University Hospital and Faculty of Medicine Pilsen, Czech Republic (I.B.) $1 https://orcid.org/0000000331427667 $7 xx0070523
700    1_
$a Bhindi, Ravinay $u Royal North Shore Hospital, University of Sydney, Australia (R.B.)
700    1_
$a Sheth, Tej $u Population Health Research Institute, McMaster University, Hamilton, Canada (R.Z., T.S., S.S.J.)
700    1_
$a Niemela, Kari $u Heart Hospital, Tampere, Finland (K.N.)
700    1_
$a Jolly, Sanjit S $u Population Health Research Institute, McMaster University, Hamilton, Canada (R.Z., T.S., S.S.J.) $1 https://orcid.org/0000000323292504
700    1_
$a Džavík, Vladimír $u Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.) $1 https://orcid.org/0000000260019534
773    0_
$w MED00161049 $t Circulation. Cardiovascular interventions $x 1941-7632 $g Roč. 15, č. 5 (2022), s. e011336
856    41
$u https://pubmed.ncbi.nlm.nih.gov/35580203 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y p $z 0
990    __
$a 20220720 $b ABA008
991    __
$a 20220804134827 $b ABA008
999    __
$a ok $b bmc $g 1822225 $s 1169773
BAS    __
$a 3
BAS    __
$a PreBMC
BMC    __
$a 2022 $b 15 $c 5 $d e011336 $e 20220517 $i 1941-7632 $m Circulation. Cardiovascular interventions $n Circ Cardiovasc Interv $x MED00161049
GRA    __
$p CIHR $2 Canada
LZP    __
$a Pubmed-20220720

Najít záznam

Citační ukazatele

Možnosti archivace