No-reflow after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: an angiographic core laboratory analysis of the TOTAL Trial
Primary result · No-reflowResult — go to the resultOdds ratio 0.95 95% CI 0.71–1.28Authors' conclusion
In patients with STEMI treated by PCI, thrombectomy did not reduce no-reflow in all patients but may be synergistic with direct stenting. No-reflow is associated with increased adverse clinical outcomes.
Study context
- Population
- ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI)randomly selected from 10,732
- Participants
- 1,800 patients
- Comparison
- Thrombectomy vs PCI alone
- Thrombectomyn = 891
- PCI alonen = 909reference
- Primary endpoint
- No-reflow
Methodological detailsangiographic core laboratory analysis
- Angiographic core laboratory analysis
Primary result
As reported in the abstract
Odds ratio
0.95
95% CI 0.71–1.28
P = 0.76
Events by treatment group
Thrombectomyvs PCI alone
OR 0.95 (95% CI 0.71–1.28); P = 0.76
- Overall no-reflow
- 196 of 1,800 (10.9%)
Further findings
| Outcome | Thrombectomy | PCI alone | OR (95% CI) | |
|---|---|---|---|---|
| No-reflow, direct stenting (subgroup) | 5.1% | 9.7% | 0.50 (0.26–0.96) | |
| Denominator | 371 | 216 | ||
| 0.20.5125Odds ratio (log scale) |
Primary composite outcome (CV death, recurrent MI, cardiogenic shock or NYHA class IV HF) in no-reflow patients · 1 year
| Adjusted HR (95% CI) | P value | ||
|---|---|---|---|
| No-reflow | 1.70 (1.13–2.56) | P = 0.01 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
No-reflow, no direct stenting (subgroup)
- No difference between the groups
- OR 1.18 1.18 (95% CI 0.82-1.69)
- 64/504 [12.7%] vs 75/686 [10.9%]
- Interaction p-value=0.02
Original publication
No-reflow after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: an angiographic core laboratory analysis of the TOTAL Trial. EuroIntervention. Published 7 August 2023. doi:10.
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