Randomized trial of primary PCI with or without routine manual thrombectomy
During primary percutaneous coronary intervention (PCI), manual thrombectomy may reduce distal embolization and thus improve microvascular perfusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results. We randomly assigned 10,732 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI to a strategy of routine upfront manual thrombectomy versus PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P=0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P=0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P=0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P=0.02). In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. (Funded by Medtronic and the Canadian Institutes of Health Research; TOTAL ClinicalTrials.gov number, NCT01149044.)..
Medienart: |
Artikel |
---|
Erscheinungsjahr: |
2015 |
---|---|
Erschienen: |
2015 |
Enthalten in: |
Zur Gesamtaufnahme - volume:372 |
---|---|
Enthalten in: |
The New England journal of medicine - 372(2015), 15, Seite 1389 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Jolly, Sanjit S [VerfasserIn] |
---|
Links: |
---|
RVK: |
---|
Förderinstitution / Projekttitel: |
|
---|
PPN (Katalog-ID): |
OLC1968372822 |
---|
LEADER | 01000caa a2200265 4500 | ||
---|---|---|---|
001 | OLC1968372822 | ||
003 | DE-627 | ||
005 | 20220223153649.0 | ||
007 | tu | ||
008 | 160206s2015 xx ||||| 00| ||eng c | ||
028 | 5 | 2 | |a PQ20160617 |
035 | |a (DE-627)OLC1968372822 | ||
035 | |a (DE-599)GBVOLC1968372822 | ||
035 | |a (PRQ)pubmed_primary_258537430 | ||
035 | |a (KEY)0171808820150000372001501389randomizedtrialofprimarypciwithorwithoutroutineman | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
082 | 0 | 4 | |a 610 |q DNB |
084 | |a XA 10000 |q AVZ |2 rvk | ||
084 | |a 44.60 |2 bkl | ||
084 | |a 44.00 |2 bkl | ||
100 | 1 | |a Jolly, Sanjit S |e verfasserin |4 aut | |
245 | 1 | 0 | |a Randomized trial of primary PCI with or without routine manual thrombectomy |
264 | 1 | |c 2015 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ohne Hilfsmittel zu benutzen |b n |2 rdamedia | ||
338 | |a Band |b nc |2 rdacarrier | ||
520 | |a During primary percutaneous coronary intervention (PCI), manual thrombectomy may reduce distal embolization and thus improve microvascular perfusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results. We randomly assigned 10,732 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI to a strategy of routine upfront manual thrombectomy versus PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P=0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P=0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P=0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P=0.02). In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. (Funded by Medtronic and the Canadian Institutes of Health Research; TOTAL ClinicalTrials.gov number, NCT01149044.). | ||
650 | 4 | |a Stroke - etiology | |
650 | 4 | |a Myocardial Infarction - therapy | |
650 | 4 | |a Percutaneous Coronary Intervention - adverse effects | |
650 | 4 | |a Thrombectomy - adverse effects | |
650 | 4 | |a Cardiovascular Diseases - mortality | |
650 | 4 | |a Myocardial Infarction - complications | |
650 | 4 | |a Combined Modality Therapy - adverse effects | |
650 | 4 | |a Coronary Thrombosis - complications | |
650 | 4 | |a Coronary Thrombosis - therapy | |
650 | 4 | |a Heart Failure - etiology | |
650 | 4 | |a Cardiovascular Diseases - prevention & control | |
700 | 1 | |a Cairns, John A |4 oth | |
700 | 1 | |a Yusuf, Salim |4 oth | |
700 | 1 | |a Meeks, Brandi |4 oth | |
700 | 1 | |a Pogue, Janice |4 oth | |
700 | 1 | |a Rokoss, Michael J |4 oth | |
700 | 1 | |a Kedev, Sasko |4 oth | |
700 | 1 | |a Thabane, Lehana |4 oth | |
700 | 1 | |a Stankovic, Goran |4 oth | |
700 | 1 | |a Moreno, Raul |4 oth | |
700 | 1 | |a Gershlick, Anthony |4 oth | |
700 | 1 | |a Chowdhary, Saqib |4 oth | |
700 | 1 | |a Lavi, Shahar |4 oth | |
700 | 1 | |a Niemelä, Kari |4 oth | |
700 | 1 | |a Steg, Philippe Gabriel |4 oth | |
700 | 1 | |a Bernat, Ivo |4 oth | |
700 | 1 | |a Xu, Yawei |4 oth | |
700 | 1 | |a Cantor, Warren J |4 oth | |
700 | 1 | |a Overgaard, Christopher B |4 oth | |
700 | 1 | |a Naber, Christoph K |4 oth | |
700 | 1 | |a Cheema, Asim N |4 oth | |
700 | 1 | |a Welsh, Robert C |4 oth | |
700 | 1 | |a Bertrand, Olivier F |4 oth | |
700 | 1 | |a Avezum, Alvaro |4 oth | |
700 | 1 | |a Bhindi, Ravinay |4 oth | |
700 | 1 | |a Pancholy, Samir |4 oth | |
700 | 1 | |a Rao, Sunil V |4 oth | |
700 | 1 | |a Natarajan, Madhu K |4 oth | |
700 | 1 | |a ten Berg, Jurriën M |4 oth | |
700 | 1 | |a Shestakovska, Olga |4 oth | |
700 | 1 | |a Gao, Peggy |4 oth | |
700 | 1 | |a Widimsky, Petr |4 oth | |
700 | 1 | |a Džavík, Vladimír |4 oth | |
773 | 0 | 8 | |i Enthalten in |t The New England journal of medicine |d Waltham, Mass. : MMS, 1928 |g 372(2015), 15, Seite 1389 |w (DE-627)129495220 |w (DE-600)207154-X |w (DE-576)014893169 |x 0028-4793 |7 nnns |
773 | 1 | 8 | |g volume:372 |g year:2015 |g number:15 |g pages:1389 |
856 | 4 | 2 | |u http://www.ncbi.nlm.nih.gov/pubmed/25853743 |
912 | |a GBV_USEFLAG_A | ||
912 | |a SYSFLAG_A | ||
912 | |a GBV_OLC | ||
912 | |a GBV_ILN_20 | ||
912 | |a GBV_ILN_40 | ||
912 | |a GBV_ILN_105 | ||
912 | |a GBV_ILN_168 | ||
912 | |a GBV_ILN_183 | ||
912 | |a GBV_ILN_287 | ||
912 | |a GBV_ILN_290 | ||
912 | |a GBV_ILN_2004 | ||
912 | |a GBV_ILN_2006 | ||
912 | |a GBV_ILN_2008 | ||
912 | |a GBV_ILN_2012 | ||
912 | |a GBV_ILN_2021 | ||
912 | |a GBV_ILN_2219 | ||
912 | |a GBV_ILN_2414 | ||
912 | |a GBV_ILN_2424 | ||
912 | |a GBV_ILN_4012 | ||
912 | |a GBV_ILN_4112 | ||
912 | |a GBV_ILN_4125 | ||
912 | |a GBV_ILN_4126 | ||
912 | |a GBV_ILN_4219 | ||
912 | |a GBV_ILN_4256 | ||
912 | |a GBV_ILN_4305 | ||
912 | |a GBV_ILN_4306 | ||
912 | |a GBV_ILN_4310 | ||
912 | |a GBV_ILN_4315 | ||
912 | |a GBV_ILN_4320 | ||
912 | |a GBV_ILN_4323 | ||
936 | r | v | |a XA 10000 |
936 | b | k | |a 44.60 |q AVZ |
936 | b | k | |a 44.00 |q AVZ |
951 | |a AR | ||
952 | |d 372 |j 2015 |e 15 |h 1389 |