title: Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0-1 coronary flow: Insights from an all comers registry.
abstract: OBJECTIVE
  To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST-elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0-1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in-hospital clinical events, emphasizing neurological outcomes.
  
  
  BACKGROUND
  The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality.
  
  
  RESULTS
  In 850 consecutive STEMI-patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2-3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P-interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln-transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR <28%. Clinical outcomes including stroke between MT and PCI-only groups were not different.
  
  
  CONCLUSIONS
  In comparison with the group where MT was inefficient, efficient MT may modestly reduce final infarct size without a significant clinical benefit. In comparison with PCI-only, no difference was found regarding stroke. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Luz
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Silveira
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Bruno
authors.identifier: http://orcid.org/0000-0003-0107-5023
authors.initials: B
authors.lastname: Brochado
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Rodrigues
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: João Sousa
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Santos
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: Trêpa
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.|Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Santos
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.|Institute of Biomedical Sciences of "Abel Salazar", University of Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Silveira
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.|Institute of Biomedical Sciences of "Abel Salazar", University of Porto, Portugal.
authors.forename: Severo
authors.initials: S
authors.lastname: Torres
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal.
authors.forename: Adelino F
authors.initials: AF
authors.lastname: Leite-Moreira
authors.affiliation: Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.|Institute of Biomedical Sciences of "Abel Salazar", University of Porto, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000209:etiology; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: ST-elevation myocardial infarction; manual thrombectomy, area at risk