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

Luz, André; Silveira, Inês; Brochado, Bruno; Rodrigues, Patrícia; Sousa, Maria João; Santos, Raquel B.; Trêpa, Maria; Santos, Mário; Silveira, João; Torres, Severo; Leite‐Moreira, Adelino F.; Carvalho, Henrique

doi:10.1002/ccd.26959

Cited by 3 publications

(10 citation statements)

References 30 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][7][8][9]13,[17][18][19][20][21][22][23][24][25][26] we believe that our results are representative of daily clinical practice.…”

Section: Ddta Score and Mt Outcomessupporting

confidence: 87%

“…21 Routine MT is no longer recommended by clinical guidelines 1,2 although it is still used in many procedures under physicians' criteria. 4,[6][7][8] MT was used less frequently in the validation cohort, in concordance with all clinical registries, 4,5,7,28 but the TIMI 3 after MT was similar in both cohorts what might reflect that it was accurately performed. We believe that our results might help decision making for the selection of patients that obtain the highest benefit from this technique.…”

Section: Ddta Score and Mt Outcomessupporting

confidence: 53%

“…Moreover, the stroke rate in both phases of our study was very low, as also reported in the TOTAL trial 20 and more other cohorts. 6,7 Despite such low incidence (0.7 in the MT arm vs. 0.3%) the two-fold increase risk of stroke, that has been confirmed in the meta-analysis, 13 produced a relevant alarm on MT. Our study was not powered to assess the effect of MT on stroke buy it clearly demonstrates that patients with DDTA score ≥ 4 have lower in-hospital MACE (including stroke) and mortality rates and could mitigate concerns related to such a feared complication as it is stroke.…”

Section: Ddta Score and Mt Outcomesmentioning

confidence: 70%

“…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.…”

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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: Ddta Score and Mt Outcomessupporting

confidence: 87%

Section: Ddta Score and Mt Outcomessupporting

confidence: 53%

Section: Ddta Score and Mt Outcomesmentioning

confidence: 70%

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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“…This article by Luz et al suggests that in some patients there may be a benefit of mechanical thrombectomy. They retrospectively looked at a nonrandomized patient population and determined three groups of patients: those who had effective mechanicals thrombectomy, those in whom the mechanical thrombectomy was ineffective; or those who had a balloon angioplasty as the first therapy.…”

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confidence: 99%

Mechanical thrombectomy revisited is there any value?

Tommaso

2017

Cathet Cardio Intervent

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

Cordero

Freites

Escribano

et al. 2020

Journal of Cardiovascular Medicine

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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.

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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

Abstract: 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.

Cited by 3 publications

References 30 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

Mechanical thrombectomy revisited is there any value?

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

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