Evidence map›Paper›PMID 27125948›Full record

Trial reportEuropean heart journal2016

Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial.

Vinoda Sharma, Sanjit S Jolly, Tahir Hamid, Divyesh Sharma, Joseph Chiha, William Chan, Felipe Fuchs, Sanh Bui, Peggy Gao, Saleem Kassam and 11 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European heart journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed
4.0field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 46 citations in OpenAlex.

  1. 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 · 2023
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  4. Increased Thrombogenicity is Associated With Coronary Microvascular Dysfunction in Patients With STEMI-A Proof-of-Concept Study.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
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  16. Near-infrared spectroscopy to predict microvascular obstruction after primary percutaneous coronary intervention.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021
    Article
  17. Impact of thrombus aspiration in frail STEMI patients.Aging clinical and experimental research · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 12 institutions in 6 countries.

Vinoda SharmaPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Sanjit S JollyThe Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada.
Tahir HamidPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Divyesh SharmaPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Joseph ChihaPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
William ChanPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Felipe FuchsPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Sanh BuiPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Peggy GaoThe Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada.
Saleem KassamRouge Valley Health System, Toronto, ON, Canada.
Raymond C M LeungCK Hui Heart Centre, Edmonton, AB, Canada.
David HorákKrajskáNemocnice Liberec, Liberec, Czech Republic.
Hannu O RomppanenHeart Centre, Kuopio University Hospital, Kuopio, Finland.
Magdi El-OmarCentral Manchester Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Saqib ChowdharyCentral Manchester Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Goran StankovićClinical Center of Serbia, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia.
Saško KedevUniversity Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, Macedonia.
Michael J RokossThe Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada.
Tej ShethThe Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada.
Vladimír DžavíkPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4.
Christopher B OvergaardPeter Munk Cardiac Centre, University Health Network, 6 Eaton North Room 232, Toronto, ON, Canada Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4 chris.overgaard1@gmail.com.
Toronto General Hospital · CAUniversity Health Network · CAManchester Academic Health Science Centre · GBCanadian Heart Research Centre · CAHamilton General Hospital · CAHamilton Health Sciences · CAKrajská Nemocnice Liberec · CZKuopio University Hospital · FIMcMaster University · CAPopulation Health Research Institute · CASaints Cyril and Methodius University of Skopje · MKUniversity of Belgrade · RS

Funding

CIHR
6 · The paper itself

Abstract

aimsThrombectomy during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) has been thought to be an effective therapy to prevent distal embolization and improve microvascular perfusion. The TOTAL trial (N = 10 732), a randomized trial of routine manual thrombectomy vs. PCI alone in STEMI, showed no difference in the primary efficacy outcome. This angiographic sub-study was performed to determine if thrombectomy improved microvascular perfusion as measured by myocardial blush grade (MBG). METHODS AND

resultsOf the 10 732 patients randomized, 1610 randomly selected angiograms were analysable by the angiographic core laboratory. Primary outcomes included MBG and post-PCI thrombolysis in myocardial infarction (TIMI) flow grade. Secondary outcomes included distal embolization, PPCI complications, and each component of the complications. The primary end point of final myocardial blush (221 [28%] 0/1 for thrombectomy vs. 246 {30%} 0/1 for PCI alone group, P = 0.38) and TIMI flow (712 [90%] TIMI 3 for thrombectomy vs. 733 [89.5%] TIMI 3 for PCI alone arm, P = 0.73) was similar in the two groups. Thrombectomy was associated with a significantly reduced incidence of distal embolization compared with PCI alone (56 [7.1%] vs. 87 [10.7%], P = 0.01). In multivariable analysis, distal embolization was an independent predictor of mortality (HR 3.00, 95% CI 1.19-7.58) while MBG was not (HR 2.73, 95% CI 0.94-5.3).

conclusionsRoutine thrombectomy during PPCI did not result in improved MBG or post-PCI TIMI flow grade but did reduce distal embolization compared with PCI alone. Distal embolization and not blush grade is independently associated with mortality.

Indexed as

ST Elevation Myocardial InfarctionThrombectomyAngioplasty, Balloon, CoronaryCoronary AngiographyHumansMyocardial InfarctionPercutaneous Coronary InterventionTreatment OutcomeMyocardial Blush GradeSTEMIThrombectomy

Identifiers

PMID27125948
PMCPMC4917747
OpenAlexW2343723890

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.