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Cordero A, Cid-Alvarez B, Alegría E, Fernández-Cisnal A, Escribano D, Bautista J, Juskova M, Trillo R, Bertomeu-Gonzalez V, Ferreiro JL. Multicenter and all-comers validation of a score to select patients for manual thrombectomy, the DDTA score. Catheter Cardiovasc Interv 2021; 98:E342-E350. [PMID: 33829625 DOI: 10.1002/ccd.29689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/08/2022]
Abstract
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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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.,Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Belén Cid-Alvarez
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospitalario de Santiago, Santiago de Compostela, Santiago, Spain
| | - Eduardo Alegría
- Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | - Jenniffer Bautista
- Cardiology Department, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Juskova
- Cardiology Department, Complejo Hospitalario de Santiago, Santiago de Compostela, Santiago, Spain
| | - Ramiro Trillo
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospitalario de Santiago, Santiago de Compostela, Santiago, Spain
| | | | - José Luis Ferreiro
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Spain
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Cordero A, Freites A, Escribano D, Bertomeu-Martínez V, Zuazola P, Badimon L. A simple score to select patients for manual thrombectomy in emergent percutaneous coronary interventions: the DDTA score. J Cardiovasc Med (Hagerstown) 2020; 21:595-602. [PMID: 32520860 DOI: 10.2459/jcm.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid
| | - Alfonso Freites
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante
| | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante
| | | | - Pilar Zuazola
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante
| | - Lina Badimon
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid.,Institut Català de Ciències Cardiovasculars (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Tommaso CL. Mechanical thrombectomy revisited is there any value? Catheter Cardiovasc Interv 2017; 90:540. [PMID: 28990340 DOI: 10.1002/ccd.27342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 11/05/2022]
Abstract
The use of mechanical thrombectomy in STEMI with large amount of jeopardized myocardium may preserve regional wall motion When appropriate and done with proper removal technique, there does not appear to be any increased incidence of neurologic complications The guideline recommendation that mechanical thrombectomy should not be done routinely is supported by these authors.
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Affiliation(s)
- Carl L Tommaso
- Cardiac Catheterization Laboratories, North Shore University Health System, Rush Medical School, 2151 Waukegan Road, Bannockburn, Illinois, 60015
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