Marc-André d'Entremont; Ashraf Alazzoni; Vladimir Dzavik; Vinoda Sharma; Christopher Overgaard; Samuel Lemaire-Paquette; Pablo Lamelas; John Cairns; Shamir  R. Mehta; Madhu  K. Natarajan; Tej Sheth; John-David Schwalm; Sunil  V. Rao; Goran Stankovic; Sasko Kedev; Raul Moreno; Warren  J. Cantor; Shahar Lavi; Olivier  F. Bertrand; Michel Nguyen; Étienne  L. Couture; Sanjit Jolly

doi:10.4244/EIJ-D-23-00112

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Clinical research

DOI: 10.4244/EIJ-D-23-00112

No-reflow after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: an angiographic core laboratory analysis of the TOTAL Trial

Marc-André d'Entremont¹^,², MD, MPH; Ashraf Alazzoni³, MD; Vladimir Dzavik⁴, MD; Vinoda Sharma⁵, MBBS; Christopher B. Overgaard⁶, MD; Samuel Lemaire-Paquette¹, MSc; Pablo Lamelas⁷, MD; John A. Cairns⁸, MD; Shamir R. Mehta²^,⁹, MD, MSc; Madhu K. Natarajan²^,⁹, MD, MSc; Tej N. Sheth²^,⁹, MD; John-David Schwalm²^,⁹, MD, MSc; Sunil V. Rao¹⁰, MD; Goran Stankovic¹¹, MD; Sasko Kedev¹², MD; Raul Moreno¹³, MD; Warren J. Cantor⁶, MD; Shahar Lavi¹⁴, MD; Olivier F. Bertrand¹⁵, MD, PhD; Michel Nguyen¹, MD; Étienne L. Couture¹, MD, MPH; Sanjit S. Jolly²^,⁹, MD, MSc

Abstract

Background: The optimal strategy to prevent no-reflow in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) is unknown.

Aims: We aimed to examine the effect of thrombectomy on the outcome of no-reflow in key subgroups and the adverse clinical outcomes associated with no-reflow.

Methods: We performed a post hoc analysis of the TOTAL Trial, a randomised trial of 10,732 patients comparing thrombectomy versus PCI alone. This analysis utilised the angiographic data of 1,800 randomly selected patients.

Results: No-reflow was diagnosed in 196 of 1,800 eligible patients (10.9%). No-reflow occurred in 95/891 (10.7%) patients randomised to thrombectomy compared with 101/909 (11.1%) in the PCI-alone arm (odds ratio [OR] 0.95, 95% confidence interval [CI]: 0.71-1.28; p-value=0.76). In the subgroup of patients who underwent direct stenting, those randomised to thrombectomy compared with PCI alone experienced less no-reflow (19/371 [5.1%] vs 21/216 [9.7%], OR 0.50, 95% CI: 0.26-0.96). In patients who did not undergo direct stenting, there was no difference between the groups (64/504 [12.7%] vs 75/686 [10.9%)], OR 1.18, 95% CI: 0.82-1.69; interaction p-value=0.02). No-reflow patients had a significantly...

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