A Trial of Routine Aspiration Thrombectomy With Percutaneous Coronary Intervention (PCI) Versus PCI Alone in Patients With ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary PCI

NCT ID: NCT01149044

Last Updated: 2015-10-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

10732 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-08-31

Study Completion Date

2015-10-31

Brief Summary

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This is an international, randomized, controlled, parallel group study in which patients with ST-Segment Elevation Myocardial Infarction (STEMI) will be allocated to one of the following: Manual aspiration thrombectomy with Percutaneous Coronary Intervention (PCI) or PCI alone.

Detailed Description

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The hypothesis for TOTAL is that the routine use of manual aspiration thrombectomy with an aspiration catheter (Export®) with PCI compared to PCI alone will reduce the incidence of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA Class IV heart failure (HF) at 180 days in patients with STEMI undergoing primary PCI.

Conditions

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Acute Coronary Syndrome ST Elevation Myocardial Infarction Percutaneous Coronary Intervention

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Upfront Thrombectomy followed by PCI

Upfront manual aspiration thrombectomy followed by PCI

Group Type ACTIVE_COMPARATOR

Percutaneous Coronary Intervention with or without manual aspiration thrombectomy

Intervention Type PROCEDURE

PCI Alone

PCI without upfront manual aspiration thrombectomy

Group Type ACTIVE_COMPARATOR

Percutaneous Coronary Intervention with or without manual aspiration thrombectomy

Intervention Type PROCEDURE

Interventions

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Percutaneous Coronary Intervention with or without manual aspiration thrombectomy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Patients presenting with:

* Symptoms of myocardial ischemia lasting for ≥ 30 minutes AND
* Definite ECG changes indicating STEMI: ST elevation of greater than 0.1 mV in two contiguous limb leads or 0.2 mV in two contiguous precordial leads
2. Referred for primary PCI
3. Randomized within 12 hours of symptoms onset and prior to diagnostic angiography
4. Informed consent

Exclusion Criteria

1. Age ≤ 18 years
2. Prior coronary artery bypass surgery (CABG)
3. Life expectancy less than six months due to non-cardiac condition
4. Treatment with fibrinolytic therapy for qualifying index STEMI event
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Population Health Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Dr. Sanjit S. Jolly

MD MSc, FRCP(C), Interventional Cardiologist, Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sanjit S. Jolly, MD, MSc, FRCP

Role: PRINCIPAL_INVESTIGATOR

Hamilton Health Sciences Corporation

Vladimir Džavík, MD, FRCPC

Role: PRINCIPAL_INVESTIGATOR

Peter Munk Cardiac Centre, University Health Network

Locations

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Central Cardiology medical Clinic

Bakersfield, California, United States

Site Status

Emory University Hospital Midtown

Atlanta, Georgia, United States

Site Status

University of New Mexico Health Sciences Center

Albuquerque, New Mexico, United States

Site Status

Lindner Research Center at Christ Hospital

Cincinnati, Ohio, United States

Site Status

Lehigh Valley Hospital

Allentown, Pennsylvania, United States

Site Status

Geisinger Clinic

Danville, Pennsylvania, United States

Site Status

WPAHS - Allegheny General Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Northeast Clinical Trials Group

Scranton, Pennsylvania, United States

Site Status

Royal North Shore Hospital

Sydney, New South Wales, Australia

Site Status

St. George Public Hospital

Sydney, New South Wales, Australia

Site Status

Gold Coast Hospital

Southport, Queensland, Australia

Site Status

Medical University of Vienna

Vienna, , Austria

Site Status

CHR de la Citadelle

Liège, , Belgium

Site Status

Hospital Sao Lucas - PUCRS

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Irmandade da Santa Casa de Misericórdia de Porto Alegre

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Hospital Santa Isabel

Blumenau, Santa Catarina, Brazil

Site Status

Santa Casa de Marilia

Marília, São Paulo, Brazil

Site Status

Fundação Faculdade de Medicina de São José do Rio Preto

São José do Rio Preto, São Paulo, Brazil

Site Status

Hospital Mae de Deus

Porto Elegre, , Brazil

Site Status

Instituto Dante Pazzanese de Cardiologia

São Paulo, , Brazil

Site Status

Royal Alexandra Hospital

Edmonton, Alberta, Canada

Site Status

University of Alberta

Edmonton, Alberta, Canada

Site Status

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status

Victoria Heart Institute

Victoria, British Columbia, Canada

Site Status

Royal Columbian Hospital

Westminster, British Columbia, Canada

Site Status

Queen Elizabeth II Health Sciences

Halifax, Nova Scotia, Canada

Site Status

Hamilton General Hospital

Hamilton, Ontario, Canada

Site Status

London Health Sciences Centre

London, Ontario, Canada

Site Status

York PCI Group - Southlake Regional

Newmarket, Ontario, Canada

Site Status

Scarborough Cardiology Research

Scarborough Village, Ontario, Canada

Site Status

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

Toronto General Hospital

Toronto, Ontario, Canada

Site Status

CSSS de Chicoutimi

Chicoutimi, Quebec, Canada

Site Status

MUHC Royal Victoria Hospital

Montreal, Quebec, Canada

Site Status

Quebec Heart Lung Insitute

Québec, Quebec, Canada

Site Status

Shanghai Gongli Hospital

Shanghai, , China

Site Status

The First People's Hospital, Jiatong University

Shanghai, , China

Site Status

The Tenth People's Hospital Tongji University

Shanghai, , China

Site Status

Yueyang Hospital Shanghai University of TCM

Shanghai, , China

Site Status

Krasjska Nemocnice Liberec

Liberec, , Czechia

Site Status

University Hospital Pilsen

Pilsen, , Czechia

Site Status

University Hospital Kralovske Vinohrady

Prague, , Czechia

Site Status

University Hospital Motol

Prague, , Czechia

Site Status

Masaryk Hospital

Ústí nad Labem, , Czechia

Site Status

Kuopio University Hospital

Kuopio, , Finland

Site Status

Heart Center, Tampere University Hospital

Tampere, , Finland

Site Status

Chu Jean Minjoz

Besançon, , France

Site Status

CHU Albert Michallon

Grenoble, , France

Site Status

Hopital Bichat

Paris, , France

Site Status

Hopital Lariboisiere Ap-HP

Paris, , France

Site Status

Centre Hospitalier de Pau

Pau, , France

Site Status

Universitatsklinikum Bonn

Bonn, , Germany

Site Status

Elisabeth-Krankenhaus Essen

Essen, , Germany

Site Status

Clinical Association Oberallgaeu-Kempten

Immenstadt im Allgäu, , Germany

Site Status

Klinikum der Universitat Munchen

München, , Germany

Site Status

Patras University Hospital

Pátrai, , Greece

Site Status

Ahepa University Hospital

Thessaloniki, , Greece

Site Status

Semmelweis University Heart and Vascular Center

Budapest, , Hungary

Site Status

University of Szeged

Szeged, , Hungary

Site Status

St. Antonius Ziekenhuis

Nieuwegein, , Netherlands

Site Status

Waikato Hospital

Hamilton, , New Zealand

Site Status

Medical University Skopje

Skopje, , North Macedonia

Site Status

Clinical Center of Serbia

Belgrade, , Serbia

Site Status

Soonchunhyang University Cheonan Hospital

Cheonan, , South Korea

Site Status

Chonnam National University Hospital

Gwangju, , South Korea

Site Status

Kyung-Hee University Hospital

Seoul, , South Korea

Site Status

Seoul Boramae Medical Center

Seoul, , South Korea

Site Status

Hospital Universitari Germans Trias I Pujol

Baldona, , Spain

Site Status

Complexo Hospitalario A Coruna

Barcelona, , Spain

Site Status

Hospital del Mar

Barcelona, , Spain

Site Status

Hospital Vall d'Hebron

Barcelona, , Spain

Site Status

Hospital Clinico San Carlos

Madrid, , Spain

Site Status

University Hospital La Paz

Madrid, , Spain

Site Status

Hospital Son Espases

Palma de Mallorca, , Spain

Site Status

Hospital Clinico Universitario de Vigo

Vigo, , Spain

Site Status

Hampshire Hospitals NHS Fuondation Trust

Basingstoke, , United Kingdom

Site Status

Barts and The London Heart and Chest Centre

Bethnal Green, , United Kingdom

Site Status

Frimley Park Hospital, NHS Foundation Trust

Camberley, , United Kingdom

Site Status

Hull and East Yorkshire Hospitals

Hull, , United Kingdom

Site Status

Kettering General Hospital

Kettering, , United Kingdom

Site Status

Glenfield General Hospital

Leicester, , United Kingdom

Site Status

Manchester Royal Infirmary

Manchester, , United Kingdom

Site Status

University Hospital South Manchester

Manchester, , United Kingdom

Site Status

Queen Elizabeth the Queen Mother Hospital

Margate, , United Kingdom

Site Status

Sheffield Teaching Hospitals

Sheffield, , United Kingdom

Site Status

University Hospital Southampton

Southampton, , United Kingdom

Site Status

Musgrove Park Hospital

Taunton, , United Kingdom

Site Status

Countries

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United States Australia Austria Belgium Brazil Canada China Czechia Finland France Germany Greece Hungary Netherlands New Zealand North Macedonia Serbia South Korea Spain United Kingdom

References

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Jolly SS, Cairns J, Yusuf S, Meeks B, Shestakovska O, Thabane L, Niemela K, Steg PG, Bertrand OF, Rao SV, Avezum A, Cantor WJ, Pancholy SB, Moreno R, Gershlick A, Bhindi R, Welsh RC, Cheema AN, Lavi S, Rokoss M, Dzavik V. Design and rationale of the TOTAL trial: a randomized trial of routine aspiration ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI. Am Heart J. 2014 Mar;167(3):315-321.e1. doi: 10.1016/j.ahj.2013.12.002. Epub 2013 Dec 14.

Reference Type BACKGROUND
PMID: 24576514 (View on PubMed)

Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, Kedev S, Thabane L, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemela K, Steg PG, Bernat I, Xu Y, Cantor WJ, Overgaard CB, Naber CK, Cheema AN, Welsh RC, Bertrand OF, Avezum A, Bhindi R, Pancholy S, Rao SV, Natarajan MK, ten Berg JM, Shestakovska O, Gao P, Widimsky P, Dzavik V; TOTAL Investigators. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015 Apr 9;372(15):1389-98. doi: 10.1056/NEJMoa1415098. Epub 2015 Mar 16.

Reference Type RESULT
PMID: 25853743 (View on PubMed)

Alkhalil M, Kuzemczak M, Zhao R, Kavvouras C, Cantor WJ, Overgaard CB, Lavi S, Sharma V, Chowdhary S, Stankovic G, Kedev S, Bernat I, Bhindi R, Sheth T, Niemela K, Jolly SS, Dzavik V. Prognostic Role of Residual Thrombus Burden Following Thrombectomy: Insights From the TOTAL Trial. Circ Cardiovasc Interv. 2022 May;15(5):e011336. doi: 10.1161/CIRCINTERVENTIONS.121.011336. Epub 2022 May 17.

Reference Type DERIVED
PMID: 35580203 (View on PubMed)

Moxham R, Dzavik V, Cairns J, Natarajan MK, Bainey KR, Akl E, Tsang MB, Lavi S, Cantor WJ, Madan M, Liu YY, Jolly SS. Association of Thrombus Aspiration With Time and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction: A Post Hoc Analysis of the Randomized TOTAL Trial. JAMA Netw Open. 2021 Mar 1;4(3):e213505. doi: 10.1001/jamanetworkopen.2021.3505.

Reference Type DERIVED
PMID: 33769510 (View on PubMed)

Jolly SS, Cairns JA, Lavi S, Cantor WJ, Bernat I, Cheema AN, Moreno R, Kedev S, Stankovic G, Rao SV, Meeks B, Chowdhary S, Gao P, Sibbald M, Velianou JL, Mehta SR, Tsang M, Sheth T, Dzavik V; TOTAL Investigators. Thrombus Aspiration in Patients With High Thrombus Burden in the TOTAL Trial. J Am Coll Cardiol. 2018 Oct 2;72(14):1589-1596. doi: 10.1016/j.jacc.2018.07.047.

Reference Type DERIVED
PMID: 30261959 (View on PubMed)

Sheth TN, Kajander OA, Lavi S, Bhindi R, Cantor WJ, Cheema AN, Stankovic G, Niemela K, Natarajan MK, Shestakovska O, Tittarelli R, Meeks B, Jolly SS. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous Coronary Intervention Alone Trial. Circ Cardiovasc Interv. 2016 Apr;9(4):e003414. doi: 10.1161/CIRCINTERVENTIONS.115.003414.

Reference Type DERIVED
PMID: 27056766 (View on PubMed)

Jolly SS, Cairns JA, Yusuf S, Rokoss MJ, Gao P, Meeks B, Kedev S, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemela K, Bernat I, Cantor WJ, Cheema AN, Steg PG, Welsh RC, Sheth T, Bertrand OF, Avezum A, Bhindi R, Natarajan MK, Horak D, Leung RC, Kassam S, Rao SV, El-Omar M, Mehta SR, Velianou JL, Pancholy S, Dzavik V; TOTAL Investigators. Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial. Lancet. 2016 Jan 9;387(10014):127-35. doi: 10.1016/S0140-6736(15)00448-1. Epub 2015 Oct 22.

Reference Type DERIVED
PMID: 26474811 (View on PubMed)

Jolly SS, Cairns JA, Yusuf S, Meeks B, Gao P, Hart RG, Kedev S, Stankovic G, Moreno R, Horak D, Kassam S, Rokoss MJ, Leung RC, El-Omar M, Romppanen HO, Alazzoni A, Alak A, Fung A, Alexopoulos D, Schwalm JD, Valettas N, Dzavik V; TOTAL Investigators. Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction. Eur Heart J. 2015 Sep 14;36(35):2364-72. doi: 10.1093/eurheartj/ehv296. Epub 2015 Jun 29.

Reference Type DERIVED
PMID: 26129947 (View on PubMed)

Williams PD, Mamas MA, Fraser DG. A coronary artery cast. Can J Cardiol. 2011 Nov-Dec;27(6):871.e5-6. doi: 10.1016/j.cjca.2011.08.108. Epub 2011 Oct 14. No abstract available.

Reference Type DERIVED
PMID: 22000582 (View on PubMed)

Related Links

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http://www.phri.ca/

TOTAL - A Randomized Trial of Routine Aspiration Thrombectomy with Percutaneous Coronary Intervention (PCI) vs. PCI Alone in Patients with STEMI Undergoing Primary PCI (Population Health Research Institute)

Other Identifiers

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TOTAL Trial

Identifier Type: -

Identifier Source: org_study_id

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