Multicenter and all-comers validation of a score to select patients for manual thrombectomy, the DDTA score
Por:
Cordero, A, Cid-Alvarez, B, Alegria, E, Fernandez-Cisnal, A, Escribano, D, Bautista, J, Juskova, M, Trillo, R, Bertomeu-Gonzalez, V and Ferreiro, J
Publicada:
1 sep 2021
Ahead of Print:
1 abr 2021
Resumen:
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.
Filiaciones:
:
Hosp Univ San Juan, Cardiol Dept, Alicante, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Cardiol Dept, Madrid, Spain
Cid-Alvarez, B:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Cardiol Dept, Madrid, Spain
Complejo Hosp Santiago, Cardiol Dept, Santiago, Spain
Alegria, E:
Univ Francisco de Vitoria, Hosp Univ Torrejon, Madrid, Spain
Fernandez-Cisnal, A:
Hosp Clin Univ Valencia, Cardiol Dept, Valencia, Spain
:
Hosp Univ San Juan, Cardiol Dept, Alicante, Spain
Bautista, J:
Hosp Univ Bellvitge, Cardiol Dept, Lhospitalet De Llobregat, Spain
Juskova, M:
Complejo Hosp Santiago, Cardiol Dept, Santiago, Spain
Trillo, R:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Cardiol Dept, Madrid, Spain
Complejo Hosp Santiago, Cardiol Dept, Santiago, Spain
:
Hosp Univ San Juan, Cardiol Dept, Alicante, Spain
Ferreiro, J:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Cardiol Dept, Madrid, Spain
Hosp Univ Bellvitge, Cardiol Dept, Lhospitalet De Llobregat, Spain
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