Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction

Aims TOTAL (N = 10 732), a randomized trial of routine manual thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction, showed no difference in the primary efficacy outcome but a significant increase in stroke. We sought to understand these findings. Methods and results A detailed analysis of stroke timing, stroke severity, and stroke subtype was performed. Strokes were adjudicated by neurologists blinded to treatment assignment. Stroke within 30 days, the primary safety outcome, was increased [33 (0.7%) vs. 16 (0.3%), hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.13–3.75]. The difference in stroke was apparent within 48 h [15 (0.3%) vs. 5 (0.1%), HR 3.00; 95% CI 1.09–8.25]. There was an increase in strokes within 180 days with minor or no disability (Rankin 0–2) [18 (0.4%) vs. 13 (0.3%) HR 1.38; 95% CI 0.68–2.82] and in strokes with major disability or fatal (Rankin 3–6) [35 (0.7%) vs. 13 (0.3%), HR 2.69; 95% CI 1.42–5.08]. Most of the absolute difference was due to an increase in ischaemic strokes within 180 days [37 (0.7%) vs. 21 (0.4%), HR 1.71; 95% CI 1.03–3.00], but there was also an increase in haemorrhagic strokes [10 (0.2%) vs. 2 (0.04%), HR 4.98; 95% CI 1.09–22.7]. Patients that had a stroke had a mortality of 30.8% within 180 days vs. 3.4% without a stroke (P
Source: European Heart Journal - Category: Cardiology Authors: Tags: Interventional cardiology Source Type: research

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Source: Biomed Res - Category: Research Authors: Tags: J Biomed Mater Res A Source Type: research
Hongfei Gu1†, Shuang Shao2†, Jie Liu3,4,5, Zhenqian Fan2, Yu Chen2, Jingxian Ni3,4,5, Conglin Wang6, Jun Tu3,4,5, Xianjia Ning3,4,5, Yongzhong Lou1*, Bin Li1* and Jinghua Wang3,4,5* 1Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China 2Department of Endocrinology and Metabolism, The Second Hospital of Tianjin Medical University, Tianjin, China 3Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China 4Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China 5Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration i...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Hypertension is the single most important risk factor for hemorrhagic stroke, a leading cause of mortality and disability worldwide. Adherence to antihypertensive medication is essential to achieving strict blood pressure control, but poor adherence is common in clinical practice. We evaluated adherence to antihypertensive medication in patients with acute hemorrhagic stroke and its effects on long-term outcome. This was a retrospective cohort study based on a nationwide health insurance claims database in South Korea. We included 1872 hypertensive patients who were admitted with acute hemorrhagic stroke during 2002 to 201...
Source: Hypertension - Category: Cardiology Authors: Tags: Secondary Prevention, Hypertension, Compliance/Adherence, Intracranial Hemorrhage Original Articles Source Type: research
ConclusionsOver the last two decades Polish urban stroke units may have achieved a significant reduction of the occurrence of some noninfectious complications (i.e. MI, exacerbated CHF and DVT). However, the list of conditions associated with stroke unit mortality includes not only MI and exacerbated CHF but also PE, gastrointestinal bleeding and recurrent stroke.
Source: Polish Journal of Neurology and Neurosurgery - Category: Neurosurgery Source Type: research
In conclusion, a debate exists on whether aging is a disease in itself. Some authors suggest that physiological aging (or senescence) is not really distinguishable from pathology, while others argue that aging is different from age-related diseases and other pathologies. It is interesting to stress that the answer to this question has important theoretical and practical consequences, taking into account that various strategies capable of setting back the aging clock are emerging. The most relevant consequence is that, if we agree that aging is equal to disease, all human beings have to be considered as patients to be treat...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Conclusions Over the last two decades Polish urban stroke units may have achieved a significant reduction of the occurrence of some noninfectious complications (i.e. MI, exacerbated CHF and DVT). However, the list of conditions associated with stroke unit mortality includes not only MI and exacerbated CHF but also PE, gastrointestinal bleeding and recurrent stroke.
Source: Polish Journal of Neurology and Neurosurgery - Category: Neurosurgery Source Type: research
Publication date: Available online 13 June 2017 Source:The Lancet Author(s): Linxin Li, Olivia C Geraghty, Ziyah Mehta, Peter M Rothwell Background Lifelong antiplatelet treatment is recommended after ischaemic vascular events, on the basis of trials done mainly in patients younger than 75 years. Upper gastrointestinal bleeding is a serious complication, but had low case fatality in trials of aspirin and is not generally thought to cause long-term disability. Consequently, although co-prescription of proton-pump inhibitors (PPIs) reduces upper gastrointestinal bleeds by 70–90%, uptake is low and guidelines are confl...
Source: The Lancet - Category: General Medicine Source Type: research
Conclusion This impressively large global study demonstrates that the prevalence of obesity is increasing worldwide among both children and adults. It supports what has long been thought, that increased body mass index (BMI) contributes to a range of illnesses and is ultimately responsible for a large number of deaths, particularly from cardiovascular disease. One potential limitation is the use of self-reported BMI or health outcome data in some of the studies, although the majority used a specific independent measurement so this is unlikely to have biased results too much. It is also always difficult from observational d...
Source: NHS News Feed - Category: Consumer Health News Tags: Obesity Source Type: news
Conclusion This study doesn't really tell us anything we didn't already know. Aspirin has been used for many years to prevent heart attacks and strokes in people with cardiovascular disease. Aspirin's wider use is controversial, because of the potential side effects. What this study does add is an estimate of what might happen if all people in the US who were advised to take aspirin under US guidelines, actually did so. (The researchers say that 40% of men and 10% of women advised to take aspirin don't take it). The study assumes that people would get the same benefits as those seen in clinical trials of aspirin. This is u...
Source: NHS News Feed - Category: Consumer Health News Tags: Heart/lungs Medication Older people Source Type: news
ConclusionsBased on the present analysis, apixaban represents a cost-effective treatment option versus warfarin and aspirin for the prevention of stroke in patients with AF from a Greek healthcare payer perspective over a lifetime horizon.
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research
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