A simple score to select patients for manual thrombectomy in emergent percutaneous coronary interventions: the DDTA score

Abstract

Background The objective of manual thrombectomy is the removal of occlusive thrombus to improve the results of primary angioplasty. The better understanding of the factors associated with successful manual thrombectomy may provide relevant information regarding thrombus formation and resolution. Methods Observational study of all consecutive patients remitted for emergent percutaneous coronary intervention (PCI) in a single centre. Successful manual thrombectomy was considered when TIMI 3 was achieved after using the device and a score to predict successful manual thrombectomy was designed. Results We included 618 patients, 65.1% treated with manual thrombectomy. No relevant differences in clinical features or time delays were observed between patients treated with vs. without manual thrombectomy, but manual thrombectomy treated patients received more often dual antiplatelet treatment (DAPT) before PCI. Final TIMI flow 3 was achieved in most patients and more frequently in manual thrombectomy treated patients (94.8 vs. 86.6%; P < 0.01). The successful manual thrombectomy rate was 81.3% and it was higher in patients pretreated with DAPT (89.0 vs. 73.3%; P < 0.01). The time delay to first medical contact was not related to the final TIMI 3, but it was significantly and negatively related to successful manual thrombectomy. According to the multivariate analysis, we designed the DDTA score: DAPT pretreatment (2), delay less than 2 h (3) or 2–4 h (2), TIMI flow improvement after wiring the lesion (2) and age less than 55 years (3). Patients with DDTA score at least 4 had lower no-reflow, mortality and major cardiovascular complications incidence. Conclusion The DDTA score (DAPT pretreatment, time delays, TIMI flow improvement after wiring the lesion and age) identifies patients who benefit mostly from manual thrombectomy.

Multicenter and all‐comers validation of a score to select patients for manual thrombectomy, the DDTA score

“…The DDTA score is based on four variables, three of them might be available before the procedure (DAPT, delay, and age) and the other is obtained after wiring the lesion. In the design cohort, patients consulting with >4 hr since symptoms onset had the lowest rates of successful MT without affecting the final TIMI 3 flow, 11 what clearly suggested that longer time delays induce more thrombus organization.…”

“…The DDTA score is based on four variables, three of them might be available before the procedure (DAPT, delay, and age) and the other is obtained after wiring the lesion. In the design cohort, patients consulting with >4 hr since symptoms onset had the lowest rates of successful MT without affecting the final TIMI 3 flow, 11 what clearly suggested that longer time delays induce more thrombus organization. The effect of Ticagrelor administration before primary PCI was tested in the ATLANTIC trial that failed to demonstrated the primary endpoint of TIMI flow 3 before PCI 29 ; nonetheless, a subsequent subanalysis highlighted that the primary endpoint was reached in patients with delay >53 min 25 .…”

“…Primary end‐point of the analyses was TIMI 3 after MT; secondary endpoints were final TIMI 3, no‐reflow incidence, in‐hospital mortality, and in‐hospital MACE (Major cardiovascular events, what included death, heart failure, stroke, and un‐planned revascularization). The individual punctuations in DDTA score were obtained retrospectively in the analyses of the whole database according to the original report 11 (Supplementary Table 1).…”

“…It was originated using a retrospective analysis of a single center cohort. 11 For its validation, we designed an observational, multicenter and all-comers study to validate the predictive capacity of the DDTA score. The study was investigators initiated and received no external financial support.…”

“…[6][7][8][9][10] Under the premises of the unmet need of uniform and standardized tools for decision-making on MT, we designed a simple scale to estimate the probability of successful MT in P-PCI: the DDTA score. 11 The DDTA score is based on four accessible variables (dual antiplatelet treatment [DAPT] before the P-PCI, delay to P-PCI, TIMI flow improvement after wiring the lesion, and age > 55) and had a high-predictive capacity in the retrospective analysis of a single-center cohort. Thereafter, we designed a study to validate the DDTA score.…”