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Multicenter and all-comers validation of a score to select patients for manual thrombectomy, the DDTA score
Alberto Cordero1,2, Belén Cid-Alvarez2,3, Eduardo Alegría4
1Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.
Insights
Manual thrombectomy (MT) can improve outcomes in primary percutaneous coronary intervention (P-PCI) for select patients. The DDTA score effectively identifies patients who benefit most from MT, reducing complications and mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Routine manual thrombectomy (MT) is not recommended in primary percutaneous coronary intervention (P-PCI).
- Despite recommendations, MT is frequently performed in P-PCI procedures.
- The DDTA score was developed to identify patients who could benefit most from MT.
Purpose of the Study:
- To validate the DDTA score for patient selection in MT during P-PCI.
- To assess the association between the DDTA score and clinical outcomes.
- To evaluate the impact of MT on specific endpoints in relation to the DDTA score.
Main Methods:
- Multicenter observational study of consecutive patients undergoing P-PCI.
- Validation of the DDTA score against a design cohort.
- Analysis of primary endpoint (TIMI 3 after MT) and secondary endpoints (final TIMI 3, no-reflow, mortality, MACE).
- Assessment of in-hospital prognosis using the Zwolle risk score.
Main Results:
- The validation cohort (340 patients) showed similar characteristics to the design cohort (618 patients) but with less MT use.
- Higher DDTA scores were linearly associated with improved outcomes.
- MT was associated with TIMI 3 flow (OR: 4.11) and final TIMI 3 (OR: 2.44) in patients with a DDTA score ≥ 4.
- A DDTA score ≥ 4 was independently linked to reduced no-reflow, in-hospital MACE, and mortality.
Conclusions:
- MT is associated with a higher rate of final TIMI 3 flow in patients with a DDTA score ≥ 4.
- Patients with a DDTA score ≥ 4 experienced lower rates of no-reflow and in-hospital complications.
- The DDTA score is a valuable tool for selecting patients who benefit from MT in P-PCI.
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.
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