Trial reportEuropean heart journal2015
Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction.
Trial report in European heart journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Aspiration thrombectomy prior to percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis.BMC cardiovascular disorders · 2016Pooled it
- No-reflow after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: an angiographic core laboratory analysis of the TOTAL Trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Trial
- Association of Thrombus Aspiration With Time and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction: A Post Hoc Analysis of the Randomized TOTAL Trial.JAMA network open · 2021Trial
- Thrombus aspiration catheter improve the myocardial reperfusion of STEMI patients with high thrombus load during the emergency PCI operation.Journal of cardiothoracic surgery · 2019Trial
- Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial.Lancet (London, England) · 2016Trial
- Article
- Intracoronary Thrombectomy Using an Off-Label 7-F Power Aspiration System for Inferior STEMI With Large Thrombus Burden.JACC. Case reports · 2025Article
- Impact of size-dependent differences in excimer laser coronary angioplasty in ST-elevation acute myocardial infarction: nuclear scintigraphy findings.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2025Article
- Continuous mechanical aspiration thrombectomy for STEMI with high thrombus burden.Cardiology journal · 2025Article
- Temporal trends and outcomes of acute ischaemic strokes in patients hospitalised for percutaneous coronary intervention.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2024Article
- Initial experience with a novel stent-based mechanical thrombectomy device for management of acute myocardial infarction cases with large thrombus burden.Cardiovascular intervention and therapeutics · 2024Article
- Neuro-tracking catheter technology for coronary thrombus extraction: Indigo CAT RX Continuous Aspiration System - first use in Poland.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2024Article
- Stroke and Recent Myocardial Infarction, Reduced Left Ventricular Ejection Fraction, Left Ventricular Thrombus, and Wall Motion Abnormalities.Current cardiology reports · 2023Review
- Double protection in patients with a massive thrombus in the infarct-related artery - a single-center retrospective study.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2023Article
- Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analyzed by nuclear scintigraphy.The international journal of cardiovascular imaging · 2023Article
- A prospective, first-in-human use of the NeVa mechanical thrombectomy device for patients with acute coronary syndromes.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2022Article
- Routine Use of the "Penumbra" Thrombectomy Device in Myocardial Infarction: A Real-World Experience-ROPUST Study.Journal of interventional cardiology · 2022Article
- Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction.Journal of the American Heart Association · 2021Article
- Thrombus Aspiration: Is It the Art or the Science?Journal of the American Heart Association · 2021Article
- Thin-strut bioresorbable-polymer sirolimus-eluting stent use for an optimal result of rescue coronary angioplasty in acute myocardial infarction failed thrombolytic therapy: the Bangladesh National Heart Foundation Annual Conference OCT-assisted live case.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2021Article
Corrections and comments
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Authors and funding
23 authors.
Funding
Abstract
aimsTOTAL (N = 10 732), a randomized trial of routine manual thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction, showed no difference in the primary efficacy outcome but a significant increase in stroke. We sought to understand these findings. METHODS AND
resultsA detailed analysis of stroke timing, stroke severity, and stroke subtype was performed. Strokes were adjudicated by neurologists blinded to treatment assignment. Stroke within 30 days, the primary safety outcome, was increased [33 (0.7%) vs. 16 (0.3%), hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.13-3.75]. The difference in stroke was apparent within 48 h [15 (0.3%) vs. 5 (0.1%), HR 3.00; 95% CI 1.09-8.25]. There was an increase in strokes within 180 days with minor or no disability (Rankin 0-2) [18 (0.4%) vs. 13 (0.3%) HR 1.38; 95% CI 0.68-2.82] and in strokes with major disability or fatal (Rankin 3-6) [35 (0.7%) vs. 13 (0.3%), HR 2.69; 95% CI 1.42-5.08]. Most of the absolute difference was due to an increase in ischaemic strokes within 180 days [37 (0.7%) vs. 21 (0.4%), HR 1.71; 95% CI 1.03-3.00], but there was also an increase in haemorrhagic strokes [10 (0.2%) vs. 2 (0.04%), HR 4.98; 95% CI 1.09-22.7]. Patients that had a stroke had a mortality of 30.8% within 180 days vs. 3.4% without a stroke (P < 0.001). A meta-analysis of randomized trials (N = 21 173) showed an increase in risk of stroke (odds ratio 1.59; 95% CI 1.11-2.27) but a trend towards reduction in mortality odds ratio (odds ratio 0.87; 95% CI 0.76-1.00).
conclusionThrombectomy was associated with a significant increase in stroke. Based on these findings, future trials must carefully collect stroke to determine safety in addition to efficacy.
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