Background 

The objective of manual thrombectomy is the removal of occlusive thrombus to improve the results of primary angioplasty. The better understanding of the factors associated with successful manual thrombectomy may provide relevant information regarding thrombus formation and resolution.

Methods 

Observational study of all consecutive patients remitted for emergent percutaneous coronary intervention (PCI) in a single centre. Successful manual thrombectomy was considered when TIMI 3 was achieved after using the device and a score to predict successful manual thrombectomy was designed.

Results 

We included 618 patients, 65.1% treated with manual thrombectomy. No relevant differences in clinical features or time delays were observed between patients treated with vs. without manual thrombectomy, but manual thrombectomy treated patients received more often dual antiplatelet treatment (DAPT) before PCI. Final TIMI flow 3 was achieved in most patients and more frequently in manual thrombectomy treated patients (94.8 vs. 86.6%; P < 0.01). The successful manual thrombectomy rate was 81.3% and it was higher in patients pretreated with DAPT (89.0 vs. 73.3%; P < 0.01). The time delay to first medical contact was not related to the final TIMI 3, but it was significantly and negatively related to successful manual thrombectomy. According to the multivariate analysis, we designed the DDTA score: DAPT pretreatment (2), delay less than 2 h (3) or 2–4 h (2), TIMI flow improvement after wiring the lesion (2) and age less than 55 years (3). Patients with DDTA score at least 4 had lower no-reflow, mortality and major cardiovascular complications incidence.

Conclusion 

The DDTA score (DAPT pretreatment, time delays, TIMI flow improvement after wiring the lesion and age) identifies patients who benefit mostly from manual thrombectomy.

中文翻译：

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在急诊经皮冠状动脉介入治疗中选择进行手动血栓切除术的患者的简单评分：DDTA评分

背景 

手动血栓切除术的目的是清除闭塞性血栓以改善原发性血管成形术的结果。对与成功的手动血栓切除术相关的因素的更好理解可能会提供有关血栓形成和消退的相关信息。

方法 

对在同一中心接受急诊经皮冠状动脉介入治疗（PCI）的所有连续患者进行的观察性研究。成功地手动血栓时TIMI 3用的是装置和得分来预测成功地手动后达到被认为是血栓切除术设计。

结果 

我们纳入了618例患者，其中65.1％的患者接受了手动血栓切除术治疗。在接受或不接受手动血栓切除术的患者之间，未观察到临床特征或时间延迟的相关差异，但在接受PCI之前，接受手动血栓切除术治疗的患者接受双抗血小板治疗（DAPT）的频率更高。大多数患者达到了最终的TIMI血流3，在接受手动血栓切除术的患者中更为频繁（94.8对86.6％；P <0.01）。手动血栓切除术的成功率为81.3％，在接受DAPT预处理的患者中更高（89.0 vs. 73.3％；P<0.01）。初次就医的时间延迟与最终的TIMI 3无关，但与成功的手动血栓切除术有显着的负相关。根据多变量分析，我们设计了DDTA评分：DAPT预处理（2），延迟小于2小时（3）或2-4小时（2），在连接病变后TIMI血流改善（2）和年龄小于55岁年（3）。DDTA评分至少为4的患者无复流，死亡率和主要心血管并发症发生率较低。

结论 

DDTA评分（DAPT预处理，时间延迟，在病变部位和年龄连接后TIMI血流改善）可确定主要受益于手动血栓切除术的患者。