02 Jul July 2, 2015: TOTAL Trial Subgroup
TOTAL Trial Subgroup Analysis Reveals Reasons Why Routine Thrombectomy In STEMI PCI Did Not Affect Mortality Rate.
In an interview, the Principal Investigator of the TOTAL Trial, Dr. Sanjit Jolly, discusses the analysis of 1600 randomly selected patients out of the overall 10,700 patients in the TOTAL Trial. There was no mortality benefit at 30 days when comparing routine thrombectomy vs. no thrombectomy in PCI treated STEMI patients in the TOTAL Trial, although lesser powered prior studies had demonstrated a benefit. Dr. Jolly raises several important issues and questions about the current aspiration thrombectomy devices:
1. There was a 3X mortality when distal embolization occurs. Since there was no overall difference in mortality between thrombectomy and no thrombectomy, limiting or prevention of distal embolization appears to be the critical issue.
2. There was no difference in residual thrombus volume in the thrombectomy group compared to no thrombectomy group, which raises the question about the effectiveness of manual aspiration thrombectomy with current catheters.
3. Dr. Jolly raises the important question that to improve outcomes we need “a device that is potentially safer and more effective at preventing distal embolization.” That describes the MegaVac.
4. Link to the interview and transcript: http://www.medscape.com/viewarticle/846480