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ACP Journal Club |16 June 2015

In STEMI, manual thrombectomy before PCI did not reduce CV-related outcomes but increased stroke

Eric R. Bates, MD

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Jolly SS, Cairns JA, Yusuf S, et al; TOTAL Investigators. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015;372:1389-98. 25853743

Cardiology:

In patients with ST-segment elevation myocardial infarction (STEMI), what is the effect of routine upfront manual thrombectomy before primary percutaneous coronary intervention (PCI) compared with PCI alone?
Randomized controlled trial (RCT) (Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI [TOTAL]). ClinicalTrials.gov NCT01149044.
Concealed.*
Blinded* (outcome adjudication committee).
180 days.
87 hospitals in 20 countries.
10 732 adults > 18 years of age (mean age 61 y, 77% men) with STEMI who were referred for primary PCI within 12 hours of symptom onset. Exclusion criteria were previous coronary artery bypass grafting or fibrinolytic therapy.
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Bates ER. In STEMI, manual thrombectomy before PCI did not reduce CV-related outcomes but increased stroke. Ann Intern Med. ;162:JC2. doi: 10.7326/ACPJC-2015-162-12-002

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Published: Ann Intern Med. 2015;162(12):JC2.

DOI: 10.7326/ACPJC-2015-162-12-002

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