Impact of manual thrombectomy on microvascular obstruction in STEMI patients

Meier, David; Fournier, Stéphane; Masci, Pier Giorgio; Eeckhout, Éric; Antiochos, Panagiotis; Τζίμας, Γεώργιος; Stoyanov, Neyko; Muenkaew, Muenpetch; Monney, Pierre; Schwitter, Juerg; Müller, Olivier; Harbaoui, Brahim

doi:10.1002/ccd.28907

Cited by 3 publications

(6 citation statements)

References 21 publications

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“…MT use was much lower in the validation cohort, clearly in concordance with current clinical practice, but the results provide reliable evidence to support selective MT based on a simple score. Since clinical features and time delays are similar to previous reports 4,6‐9,13,17‐26 we believe that our results are representative of daily clinical practice.…”

Section: Discusionsupporting

confidence: 87%

“…Finally, the study did not assess the incidence of other clinical endpoints, such as urgent revascularization or stent thrombosis. Nonetheless, since clinical features and complications incidence were similar to previous reports 4,[6][7][8][9]13,[17][18][19][20][21][22][23][24][25][26] we believe that these limitations might have not major influence on results validity.…”

Section: Ddta Score and Mt Outcomessupporting

confidence: 77%

“…MT use has declined progressively since these recommendations were published 3‐5 although clinical registries reflect that it is still used in 10–30% of primary percutaneous coronary interventions (P‐PCI) based to operators criteria 6‐10 . 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 .…”

Section: Introductionmentioning

confidence: 99%

“…based to operators criteria. [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.…”

mentioning

confidence: 99%

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

Cordero

Cid-Álvarez

Alegría

et al. 2021

Cathet Cardio Intervent

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Background: Routine manual thrombectomy (MT) is not recommended in primary percutaneous coronary intervention (P-PCI) but it is performed in many procedures.The objective of our study was validating the DDTA score, designed for selecting patients who benefit most from MT.Methods: Observational and multicenter study of all consecutive patients undergoing P-PCI in five institutions. Results were compared with the design cohort and the performance of the DDTA was analyzed in all patients. 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 major cardiovascular events (MACE).In-hospital prognosis was assessed by the Zwolle risk score.Results: Three hundred forty patients were included in the validation cohort and no differences were observed as compared to the design cohort (618 patients) except for lower use of MT and higher IIb/IIIa inhibitors or drug-eluting stents. The probability of TIMI 3 after MT decreased as delay to P-PCI was higher. If DDTA score, MT was associated to TIMI 3 after MT (OR: 4.11) and final TIMI 3 (OR: 2.44). There was a linear and continuous relationship between DDTA score and all endpoints. DDTA score ≥ 4 was independently associated to lower no-reflow, in-hospital MACE or mortality. The lowest incidence of in-hospital mortality or MACE was in patients who had DDTA score ≥ 4 and Zwolle risk score 0-3.Conclusions: MT is associated to higher rate of final TIMI3 in patients with the DDTA score ≥ 4. Patients with DDTA score ≥ 4 had lower no-reflow and in-hospital complications.

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Section: Discusionsupporting

confidence: 87%

Section: Ddta Score and Mt Outcomessupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Cordero

Cid-Álvarez

Alegría

et al. 2021

Cathet Cardio Intervent

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“…Very few studies have evaluated the effects of AT on CMR parameters in STEMI patients and these have brought conflicting results [ 30 , 31 , 32 ]. Our CMR analysis shows that AT + PCI significantly reduced MVO, infarct size and prevented adverse LV remodelling.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance Shows Improved Outcomes in Patients with an ST-Segment Elevation Myocardial Infarction and a High Thrombus Burden Treated with Adjuvant Aspiration Thrombectomy

Zajdel

Miszalski−Jamka

Zalewski

et al. 2022

JCM

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There is a discrepancy between epicardial vessel patency and microcirculation perfusion in a third of patients treated with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Optimization with aspiration thrombectomy (AT) may reduce distal embolization and microvascular obstruction. The effect of AT in the treatment of STEMI is debatable. The purpose of this study was to use cardiac magnetic resonance (CMR) to determine whether AT influences microvascular obstruction (MVO), infarct size and left ventricular (LV) remodelling in STEMI patients. Sixty STEMI patients with a thrombus-occluded coronary artery were randomized in a 2:1 fashion to receive PCI proceeded by AT (AT + PCI group), or PCI only. MVO, myocardial infarct size and LV remodelling were assessed by CMR during the index hospitalization and 6 months thereafter. The majority of patients had a large thrombus burden (TIMI thrombus grade 5 in over 70% of patients). PCI and AT were effective in all cases. There were no periprocedural strokes. CMR showed that the addition of AT to standard PCI was associated with lesser MVO when indexed to the infarct size and larger infarct size reduction. There were less patients with left ventricle remodelling in the AT + PCI vs. the PCI only group. To conclude, in STEMI patients with a high thrombus burden, AT added to PCI is effective in reducing infarct size, MVO and LV remodelling.

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The impact of primary percutaneous coronary intervention strategies during ST-elevation myocardial infarction on the prevalence of coronary microvascular dysfunction

Aldujeli,

Haq,

Tsai

et al. 2023

Sci Rep

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Coronary microvascular dysfunction (CMD) is a common complication of ST-segment elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. This is a non-randomized, observational, prospective study of STEMI patients with multivessel disease who underwent primary PCI, grouped based on whether they underwent balloon pre-dilatation stenting or direct stenting of the culprit lesion. Coronary physiology measurements were performed 3 months post-PCI including coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) measurements at the culprit vessel. The primary endpoint was the prevalence of CMD at 3 months, defined as IMR ≥ 25 or CFR < 2.0 with a normal fractional flow reserve. Secondary endpoints included major adverse cardiovascular events (MACE) at 12 months. Two hundred ten patients were enrolled; most were men, 125 (59.5%), with a median age of 65 years. One hundred twelve (53.2%) underwent balloon pre-dilatation before stenting, and 98 (46.7%) underwent direct stenting. The prevalence of CMD at 3 months was lower in the direct stenting group than in the balloon pre-dilatation stenting group (12.24% vs. 40.18%; p < 0.001). Aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with lower odds of CMD (OR = 0.175, p = 0.001 and OR = 0.113, p = 0.001, respectively). Notably, MACE in patients who underwent direct stenting was lower than in those who underwent balloon pre-dilatation before stenting (14.29% vs. 26.79%; p = 0.040). In STEMI patients with multivessel disease, direct stenting of the culprit lesion, aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with a lower prevalence of CMD at 3 months and lower incidence of MACE at 12 months compared with balloon pre-dilatation stenting.This trial is registered at https://ichgcp.net/clinical-trials-registry/NCT05406297.

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Impact of manual thrombectomy on microvascular obstruction in STEMI patients

Cited by 3 publications

References 21 publications

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

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

Cardiac Magnetic Resonance Shows Improved Outcomes in Patients with an ST-Segment Elevation Myocardial Infarction and a High Thrombus Burden Treated with Adjuvant Aspiration Thrombectomy

The impact of primary percutaneous coronary intervention strategies during ST-elevation myocardial infarction on the prevalence of coronary microvascular dysfunction

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