RESUMO
BackgroundTwo large trials have reported contradictory results at 1 year after thrombus aspiration in ST elevation myocardial infarction (STEMI). In a 1-year follow-up of the largest randomised trial of thrombus aspiration, we aimed to clarify the longer-term benefits, to help guide clinical practice.MethodsThe trial of routine aspiration ThrOmbecTomy with PCI versus PCI ALone in Patients with STEMI (TOTAL) was a prospective, randomised, investigator-initiated trial of routine manual thrombectomy versus percutaneous coronary intervention (PCI) alone in 10 732 patients with STEMI. Eligible adult patients (aged ≥18 years) from 87 hospitals in 20 countries were enrolled and randomly assigned (1:1) within 12 h of symptom onset to receive routine manual thrombectomy with PCI or PCI alone. Permuted block randomisation (with variable block size) was done by a 24 h computerised central system, and was stratified by centre. Participants and investigators were not masked to treatment assignment. The trial did not show a difference at 180 days in the primary outcome of cardiovascular death, myocardial infarction, cardiogenic shock, or heart failure. However, the results showed improvements in the surrogate outcomes of ST segment resolution and distal embolisation, but whether or not this finding would translate into a longer term benefit remained unclear...
Assuntos
Intervenção Coronária Percutânea , Trombectomia , TromboseRESUMO
Background A major limitation of primary percutaneous coronary intervention (PPCI) for the treatment of ST-elevation
myocardial infarction (STEMI) is impaired microvascular perfusion due to embolization and obstruction of microcirculation with
thrombus. Manual thrombectomy has the potential to reduce distal embolization and improve microvascular perfusion. Clinical
trials have shown mixed results regarding thrombectomy.
Objective The objective of this study is to evaluate the efficacy of routine upfront manual aspiration thrombectomy during
PPCI compared with percutaneous coronary intervention alone in patients with STEMI.
Design This is a multicenter, prospective, open, international, randomized trial with blinded assessment of outcomes.
Patients with STEMI undergoing PPCI are randomized to upfront routine manual aspiration thrombectomy with the Export
catheter (Medtronic CardioVascular, Santa Rosa, CA) or to percutaneous coronary intervention alone. The primary outcome is
the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening New York
Heart Association class IV heart failure up to 180 days. The trial uses an event-driven design and will recruit 10,700 patients.
Summary The TOTAL trial will determine the effect of routine manual aspiration thrombectomy during PPCI on clinically
Assuntos
Infarto , Intervenção Coronária Percutânea , TrombectomiaRESUMO
OBJECTIVE: The objective of this study was to evaluate the efficacy of hemostasis with patency in avoiding radial artery occlusion after transradial catheterization. BACKGROUND: Radial artery occlusion is an infrequent but discouraging complication of transradial access. It is related to factors such as sheath to artery ratio and is less common in patients receiving heparin. Despite being clinically silent in most cases, it limits future transradial access. PATIENTS AND METHODS: Four hundred thirty-six consecutive patients undergoing transradial catheterization were prospectively enrolled in the study. Two hundred nineteen patients were randomized to group I, and underwent conventional pressure application for hemostasis. Two hundred seventeen patients were randomized to group II and underwent pressure application confirming radial artery patency using Barbeau's test. Radial artery patency was studied at 24 hr and 30 days using Barbeau's test. RESULTS: Thirty-eight patients had evidence of radial artery occlusion at 24 hr. Twenty patients had persistent evidence of radial artery occlusion at 1 month. Group II, with documented patency during hemostatic compression, had a statistically and clinically lower incidence of radial artery occlusion (59% decrease at 24 hr and 75% decrease at 30 days, P < 0.05), compared with patients in group I. Low body weight patients were at significantly higher risk of radial artery occlusion. No procedural variables were found to be associated with radial artery occlusion. CONCLUSION: Patent hemostasis is highly effective in reducing radial artery occlusion after radial access and guided compression should be performed to maintain radial artery patency at the time of hemostasis, to prevent future radial artery occlusion.