Evidence map›Paper›PMID 37382909›Full record

Trial reportEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2023

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'Entremont, Ashraf Alazzoni, Vladimir Dzavik, Vinoda Sharma, Christopher B Overgaard, Samuel Lemaire-Paquette, Pablo Lamelas, John A Cairns, Shamir R Mehta, Madhu K Natarajan and 12 more

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

Trial report in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed
4.6field-weighted citation impact, top 4% 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

17 citing papers in PubMed, 21 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
  4. Article
  5. Mechanical thrombectomy with the Penumbra system in a patient with acute myocardial infarction.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2025
    Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Observational
  16. The role and mechanisms of microvascular damage in the ischemic myocardium.Cellular and molecular life sciences : CMLS · 2023
    Review
  17. Angiographic coronary no-reflow after primary percutaneous coronary intervention - a combination of an insensitive diagnostic method, inappropriate timing and rushed judgement.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 12 institutions in 4 countries.

Marc-André d'EntremontSherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada.
Ashraf AlazzoniCleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Vladimir DzavikPeter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
Vinoda SharmaBirmingham City Hospital, University of Birmingham, Birmingham, UK.
Christopher B OvergaardSouthlake Regional Health Centre, University of Toronto, Toronto, ON, Canada.
Samuel Lemaire-PaquetteSherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada.
Pablo LamelasInstituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
John A CairnsVancouver Coastal Health Research Institute, Vancouver, BC, Canada.
Shamir R MehtaPopulation Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
Madhu K NatarajanPopulation Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
Tej N ShethPopulation Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
John-David SchwalmPopulation Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
Sunil V RaoNew York University Langone Health, New York, NY, USA.
Goran StankovicDepartment of Cardiology, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
Sasko KedevUniversity Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia.
Raul MorenoUniversity Hospital La Paz, Madrid, Spain.
Warren J CantorSouthlake Regional Health Centre, University of Toronto, Toronto, ON, Canada.
Shahar LaviLondon Health Sciences Centre, London, ON, Canada.
Olivier F BertrandQuebec Heart and Lung Institute, Quebec City, QC, Canada.
Michel NguyenSherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada.
Étienne L CoutureSherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada.
Sanjit S JollyPopulation Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
Population Health Research Institute · CAMcMaster University · CASouthlake Regional Health Center · CACleveland Clinic · USHamilton Health Sciences · CAHospital Universitario La Paz · ESInstituto Cardiovascular de Buenos Aires · ARLondon Health Sciences Centre · CAMontreal Heart Institute · CANYU Langone Health · USUniversity Health Network · CAVancouver Coastal Health Research Institute · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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

aimsWe 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.

methodsWe 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.

resultsNo-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 increased risk of experiencing the primary composite outcome (cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA Class IV heart failure) at 1 year (adjusted hazard ratio 1.70, 95% CI: 1.13-2.56; p-value=0.01).

conclusionsIn 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.

Indexed as

Myocardial InfarctionPercutaneous Coronary InterventionST Elevation Myocardial InfarctionCoronary AngiographyHumansShock, CardiogenicTreatment Outcome

Identifiers

PMID37382909
PMCPMC10397677
OpenAlexW4382501261

What Socratic 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 Socratic graph.