TOTAL: Thrombus Aspiration During PCI in STEMI Patients

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), routine thrombus aspiration did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock or class IV heart failure within one year, as compared to PCI alone, according to results of the TOTAL trial presented Oct. 13 at TCT 2015 and simultaneously published in the Lancet.

Led by Sanjit S. Jolly, MD, et al., researchers sought to evaluate the benefits of thrombus aspiration STEMI patients at one-year follow-up. A total of 10,064 STEMI patients were divided in to two groups, the first of which underwent PCI with manual thrombectomy and the second group received PCI alone.

The results of the study showed that routine thrombus aspiration did not reduce longer-term clinical outcomes in STEMI patients during PCI within one year, as shown by the equal rate of mortality (4 percent) in the both groups of patients. Further, the results indicate that thrombus aspiration may be associated with increased risk of stroke.

According to Jolly, “the TOTAL trial is the largest trial of thrombus aspiration with significantly more power to detect differences in which stroke was a pre-specified safety outcome. As a result, thrombus aspiration can no longer be recommended as a routine strategy in STEMI.”

The study is an update to research presented at ACC.15 in San Diego, CA, this past March by Jolly.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure

Keywords: Transcatheter Cardiovascular Therapeutics, Cardiovascular Diseases, Myocardial Infarction, Thrombosis, Heart Failure, Percutaneous Coronary Intervention, Shock, Cardiogenic, Stroke, Thrombectomy

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