May 1, 2022Circulation Cardiovascular Interventions
Prognostic Role of Residual Thrombus Burden Following Thrombectomy: Insights From the TOTAL Trial
Key result
Large residual thrombus burden after manual thrombectomy during primary PCI was associated with increased risk of the primary composite outcome (8.6% vs 4.6%; adjusted HR 1.83; 95% CI 1.34-2.48).
Why the study?
It was unclear whether more effective forms of thrombus removal than current aspiration catheters would lead to improved clinical outcomes.
Is large residual thrombus burden after manual thrombectomy associated with increased adverse cardiovascular outcomes in patients undergoing primary percutaneous coronary intervention?
Population
2869 patients with quantifiable rTB after manual thrombectomy during primary PCI in the TOTAL trial
Comparison
Large rTB (grade ≥3) vs rTB grade <3
Design
Single-arm post-hoc analysis of a randomized trial
Follow-up
180 days
Authors
Discussion
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Implication
May identify higher-risk primary PCI patients; hypothesis-generating for adjunctive thrombus strategies.
Study Design
Type
Observational (n=2,869)
Structured PICO
Is large residual thrombus burden after manual thrombectomy associated with increased adverse cardiovascular outcomes in patients undergoing primary percutaneous coronary intervention?
P
Population
2,869 patients undergoing primary percutaneous coronary intervention with routine manual aspiration thrombectomy who had quantifiable residual thrombus burden (from the TOTAL trial).
I
Intervention
Large residual thrombus burden (grade ≥3)
C
Comparator
Small or no residual thrombus burden (grade <3)
O
Outcome
Composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening heart failure within 180 dayscomposite
Main Result
Effect estimate: adjusted HR 1.83 (95% CI 1.34-2.48)
Absolute Event Rate: 8.6% vs 4.6%
Large residual thrombus burden following manual thrombectomy in primary PCI is an independent predictor of adverse cardiovascular outcomes at 180 days.
Cite This Study
Alkhalil et al. (2022) conducted an observational in Myocardial infarction undergoing primary percutaneous coronary intervention (n=2,869). Large residual thrombus burden (grade ≥3) vs. Non-large residual thrombus burden was evaluated on Death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening heart failure within 180 days (adjusted HR 1.83, 95% CI 1.34-2.48). Large residual thrombus burden after manual thrombectomy during primary PCI was associated with increased risk of the primary composite outcome (8.6% vs 4.6%; adjusted HR 1.83; 95% CI 1.34-2.48).