Thrombus aspiration for reperfusion in myocardial infarction: Predictors and clinical impact of ineffectiveness | Revista Portuguesa de Cardiologia (English edition)

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TA: thrombus aspiration." ] ] ] "textoCompleto" => "Introduction and ObjectivesThe benefit of manual thrombus aspiration (TA) as an adjunctive technique in the reperfusion of patients with ST-elevation myocardial infarction (STEMI) has been hotly debated. The advantage of TA during primary percutaneous coronary (PPCI) is that it reduces the risk of distal embolization of thrombotic material during the procedure, thus improving microvascular perfusion and reducing infarct size.<a class="elsevierStyleCrossRefs" href="#bib0005">1–6</a> Compared to mechanical thrombus removal, manual TA is simpler to perform and is of equal or superior efficacy.<a class="elsevierStyleCrossRefs" href="#bib0035">7–9</a>The introduction of manual TA aroused great interest and it is now widely used in interventional cardiology; it has a class IIa recommendation, level of evidence B, in the European Society of Cardiology guidelines for the management of STEMI.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Nevertheless, there is considerable variation in use of this technique as adjunctive therapy to reperfusion.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> In a recent survey, manual TA was used in less than 20% of PPCI procedures in the US.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Although some randomized studies have demonstrated clinical benefit by reducing major cardiovascular events,<a class="elsevierStyleCrossRefs" href="#bib0065">13–15</a> subsequently confirmed in meta-analyses,<a class="elsevierStyleCrossRefs" href="#bib0040">8,16–18</a> other series, including one large-scale study, have not shown the same clinical efficacy.<a class="elsevierStyleCrossRefs" href="#bib0095">19–22</a> However, TA may not be possible in some cases (10% of patients scheduled for TA in the TAPAS study<a class="elsevierStyleCrossRef" href="#bib0065">13</a>). The effect of failure of TA in patients in whom it was considered to be indicated has been largely unreported.The primary objective of this study was to identify the predictors of TA failure in a consecutive series of STEMI patients referred for PPCI, in which TA was systematically used as the first option (bail-out procedures were excluded). The secondary objective was to assess the impact of failed TA on cumulative mortality (cardiac and non-cardiac) in the medium term.MethodsStudy population and definitionsThis was a single-center retrospective study of consecutive STEMI patients admitted for PPCI between January 2008 and December 2013. Patients undergoing coronary artery bypass grafting were excluded. Clinical, laboratory and procedural data from admission to discharge were collected from hospital records. The vital status of patients during follow-up was assessed by consulting medical records or contact with the attending physician, the patient or relatives. The diagnosis of STEMI was based on clinical criteria, together with the following ECG alterations: ST-segment elevation of ≥0.15 mV in V2-V3 or of ≥0.1 mV in at least two other leads, ST depression of ≥0.15 mm in V2-V3 with positive T wave (posterior infarction), or new-onset complete left bundle branch block. Only patients undergoing manual TA for a documented thrombus in an epicardial coronary artery and TIMI flow 0 or 1 were included in the study.No reflow was considered present if after angioplasty distal coronary flow was TIMI <2, or TIMI 2–3 with no contrast perfusing the myocardial capillary territory (myocardial perfusion grade 0), or if, after perfusion, stagnation of contrast was observed (myocardial perfusion grade 1), in the absence of spasm, dissection, or epicardial coronary thrombus, that persisted after intracoronary administration of nitroglycerin and adenosine. TA was considered ineffective if, before angioplasty (balloon and/or stent), coronary flow was TIMI <2 and effective with TIMI 2–3.Total ischemic time (TIT) was defined as the delay between symptom onset (intense, persistent chest pain) and introduction of the guidewire for PPCI. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault formula.All patients were risk stratified using the GRACE scores<a class="elsevierStyleCrossRef" href="#bib0230">23</a> for in-hospital and six-month mortality and the TIMI risk score for STEMI.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> The complexity of coronary artery disease was classified using the on-line calculator for the SYNTAX score,<a class="elsevierStyleCrossRef" href="#bib0125">25</a> version 2.11, all lesions with >50% stenosis in vessels of >1.5 mm being included in the analysis. The culprit artery was defined as the one occluded within the previous three months. The area of myocardium at risk was calculated using the modified APPROACH score,<a class="elsevierStyleCrossRef" href="#bib0130">26</a> an angiographic score that estimates the proportion of myocardium that is supplied by a coronary segment based on vessel dominance and caliber. This score is easy to calculate and correlates well with the area at risk as assessed by cardiac magnetic resonance (CMR).<a class="elsevierStyleCrossRefs" href="#bib0135">27,28</a> For example, for the proximal anterior descending artery, the area at risk is estimated at 47.75% if there is a large diagonal vessel downstream of the occlusion and at 41.25% if the diagonal is small or nonexistent. The angiographic analyses were performed by two senior interventional cardiologists; in doubtful cases, the scores were arrived at by consensus or taken as the mean of the individual observations.Left ventricular ejection fraction (LVEF) was assessed by two-dimensional echocardiography (Philips iE33, Eindhoven, The Netherlands) by Simpson's method. LVEF was considered preserved if ≥55%, mildly depressed if ≥45% and <55%, moderately depressed if ≥30% and <45%, and severely depressed if <30%. For the purposes of the statistical analysis, LVEF was classified as preserved or mild dysfunction and moderate or severe dysfunction.Overall cumulative mortality (cardiac and non-cardiac, in-hospital and during follow-up) was considered a major cardiovascular event. Only patients with a follow-up of ≥12 months after STEMI were included in the analysis.Procedure and medicationAll patients were medicated with aspirin 300 mg and clopidogrel 600 mg prior to PPCI unless they were already taking these drugs. A 6F or 7F introducer was used. Unfractionated heparin (70 U/kg) was administered during the procedure. Use of glycoprotein IIb/IIIa inhibitors and selection of type of stent and other adjunctive devices were at the operator's discretion. Manual TA was performed using a 6F Export aspiration catheter (Medtronic, Minneapolis, MN, USA) in all cases. Following PPCI, patients were admitted to the coronary care unit. Myocardial necrosis markers (troponin T [TnT], creatine kinase [CK] and CK-MB) were measured at 6, 12, 24 and 48 h after reperfusion. All patients were prescribed aspirin 100 mg/day and clopidogrel 75 mg/day at discharge, together with other medication considered appropriate according to the guidelines.Statistical analysisThe Kolmogorov-Smirnov test was used to assess the normality of distribution of continuous variables, which were expressed as means ± standard deviation or interquartile range for those with normal and non-normal distribution, respectively. Variables with normal distribution were compared by the Student's t test for independent samples, while those with non-normal distribution were compared by the Mann-Whitney test. Categorical variables were expressed as frequencies and percentages and compared by the chi-square test or by Fisher's exact test. Peak TnT, CK and CK-MB were logarithmically transformed for parametric tests. A logistic regression model was used to identify predictors of TA failure with failed TA as a dependent variable. Unadjusted mortality according to TA efficacy was calculated using the Kaplan-Meier method, the difference being obtained by the log rank test. Cumulative mortality adjusted for confounding variables was assessed using a Cox model. Variables with p<0.1 on univariate analysis were included in the multivariate analysis in order to identify independent predictors. In order to avoid overadjustment, the GRACE and TIMI scores were not included in the regression analysis. A two-tailed p value of p<0.05 was considered significant. The statistical analysis was performed using SPSS version 20 (SPSS, Chicago, IL, US).ResultsOf a total of 614 patients with STEMI, 40 were excluded due to lack of data. Of the 574 assessed, TA was used in 417 (72.6%), and was effective in 365 (87.5%) and ineffective in 52 (12.5%). In the latter group, the lesion could not be crossed in four cases (4/52, 7.7%); the operator proceeded to balloon dilatation of the lesions, but TA was attempted again in only one of these patients, which was also unsuccessful. <a class="elsevierStyleCrossRefs" href="#tbl0020">Tables 1 and 2</a> summarize the clinical and procedure-related characteristics, respectively, of the study population, according to the efficacy of TA. TA failure was significantly associated with non-smokers, higher GRACE and SYNTAX scores and Killip class at admission, and longer TIT. With regard to the procedure, the circumflex was less frequently the culprit artery, and an intra-aortic balloon pump was more frequently used in those with ineffective TA. There was a tendency for a higher rate of previous therapy with nitrates and calcium channel blockers in the ineffective TA group, and lower hemoglobin at admission. In terms of in-hospital outcome (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), the rate of no reflow was higher in those with failed TA. No significant differences were found in peak CK, CK-MB or TnT, or in LVEF at discharge, although it should be noted that enzyme peaks could not be measured in the first 24 h in 21 patients (3.7%), mainly due to death soon after the procedure (n=19 [90.5%]). Of these 21 patients, TA was used in 12 (57.1%), and was effective in seven (58.3%) and ineffective in five (41.7%). Hospital stay was longer in the ineffective TA group. Mortality was also higher (13.5% vs. 6%, p=0.073) in this group, but without statistical significance.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>On univariate analysis, age, SYNTAX score, current smoking, admission hemoglobin, previous therapy with nitrates or calcium channel blockers, TIT and Killip class III/IV at admission correlated with ineffective TA. In multivariate analysis, only SYNTAX score (odds ratio [OR]: 1.049, 95% confidence interval [CI]: 1.015–1.084, p=0.005) and TIT (OR: 1.001, 95% CI: 1.000–1.003, p=0.02) were independent predictors.We identified 331 patients with at least 12 months of follow-up after STEMI. It was not possible to ascertain vital status in two of these (0.6%), and so 329 patients were included in the analysis of medium-term mortality (mean follow-up: 24±0.82 months, cumulative mortality rate: 13.9%). Unadjusted cumulative mortality was higher in the ineffective TA group (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). After adjustment for covariables with p<0.1 on univariate analysis (gender, age, TA efficacy, APPROACH and SYNTAX scores, current smoking, TIT, CrCl, target vessel, intra-aortic balloon pump, hemoglobin, systolic blood pressure, Killip class III/IV at admission and LVEF at discharge), LVEF showing moderate or severe dysfunction (hazard ratio [HR]: 6.256, 95% CI: 1.896–20.644, p=0.003), APPROACH score (HR: 1.094, 95% CI: 1.016–1.177, p=0.017), and Killip class III/IV (HR: 2.953, 95% CI: 1.122–7.770, p=0.028) showed a positive correlation with mortality, while higher CrCl values had a protective effect (HR: 0.973, 95% CI: 0.953–0.994, p=0.011).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionIn this series, TA was scheduled in the majority of patients (72.6%), and was effective in most cases (87.5%). It is plausible that the more organized the thrombus, the less effective TA will be, and it is thus not surprising that the longer the delay between symptom onset and reperfusion, the greater the likelihood of TA failure. The correlation between TIT and thrombus organization as a predictor of adverse events has been reported in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0145">29–32</a> However, the relationship between SYNTAX score and TA failure is unknown. The technique is more likely to be unsuccessful in patients with unfavorable coronary anatomy such as tortuosity or calcification, or with a large amount of plaque that is at risk of distal embolization, resulting in impaired microvascular perfusion. A correlation between SYNTAX score and risk of no reflow has been demonstrated in some series of patients undergoing PPCI.<a class="elsevierStyleCrossRef" href="#bib0165">33</a>Excluding patients in whom TA was not performed, for example because the vessel involved was of small caliber or there was insufficient thrombotic material to justify TA, systematic use of the technique might be expected to reduce infarct size when effective. However, this assumption was not confirmed in our series. Although peak enzyme levels can only estimate infarct size, they correlate well with infarct size as assessed by CMR.<a class="elsevierStyleCrossRefs" href="#bib0170">34,35</a> In studies using CMR to assess the area of necrosis, patients undergoing TA did not show reduced infarct size,<a class="elsevierStyleCrossRefs" href="#bib0110">22,36</a> even in cases with less microvascular obstruction.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>With regard to mortality, no significant differences in clinical endpoints would be expected in view of the small sample size. However, the trend observed in in-hospital mortality could be more marked in larger series. Unsurprisingly, in the patient subgroup assessed for cumulative mortality, LVEF showing moderate to severe dysfunction and Killip class III/IV were strong independent predictors of medium-term mortality. These two parameters,<a class="elsevierStyleCrossRefs" href="#bib0185">37–39</a> together with the area of myocardium at risk,<a class="elsevierStyleCrossRef" href="#bib0200">40</a> have been reported as markers of adverse prognosis. An interesting possibility is that TA may only have a significant impact in patients with large areas of at-risk myocardium,<a class="elsevierStyleCrossRef" href="#bib0205">41</a> but specially designed prospective studies are needed to confirm this hypothesis. Renal failure has often been cited as an independent cause of mortality in STEMI patients,<a class="elsevierStyleCrossRefs" href="#bib0210">42,43</a> and so it is to be expected that higher CrCl values are associated with a protective effect.The debate concerning the benefits of TA in reperfusion is far from consensus.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> The conflicting results of studies published to date may be due to sample sizes being too small to assess clinical endpoints and to different methods of evaluating coronary microvascular perfusion. At the same time, it appears that not all patients benefit to the same extent from TA, reflecting the heterogeneity of STEMI patients. Only large-scale studies or meta-analyses will provide solid evidence on the most important clinical endpoints, and so our results concerning mortality should be interpreted with caution. It is known that patients with no reflow have increased long-term mortality.<a class="elsevierStyleCrossRef" href="#bib0225">45</a> The significant relationship found between no reflow and ineffective TA may be reflected in increased cumulative mortality in larger series, which would enable this association to be studied in more detail. Overall, the results of this observational study are similar to the latest series comparing TA with conventional PPCI. With the exception of a lower rate of no reflow, effective TA did not result in an unequivocal benefit compared to ineffective TA.Study limitationsLimitations include the fact that this was a single-center retrospective study and with too small a sample size to assess the impact of TA efficacy on medium-term mortality. The rate of TA failure was low (<15%), which may have affected the results.ConclusionsIn our series, TA was ineffective in 12.5% of cases, and TIT and SYNTAX score were independent predictors of TA failure. On multivariate analysis, ineffective TA was not related to larger infarct size or increased medium-term mortality.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres407241" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and Objectives" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec383481" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres407242" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução e objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec383482" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction and Objectives" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population and definitions" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure and medication" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-02-21" "fechaAceptado" => "2014-05-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec383481" "palabras" => array:4 [ 0 => "Thrombectomy" 1 => "ST-elevation myocardial infarction" 2 => "Reperfusion" 3 => "Thrombus aspiration" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec383482" "palabras" => array:4 [ 0 => "Trombectomia" 1 => "Enfarte agudo de miocárdio" 2 => "Reperfusão" 3 => "Aspiração de trombo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectivesThe benefit of manual thrombus aspiration (TA) in the reperfusion of patients with ST-elevation myocardial infarction (STEMI) has been hotly debated. In most series, failure of TA has been largely unreported. Our objectives were to assess the rate, predictors, and impact on cumulative mortality of failed TA during primary percutaneous coronary intervention (PPCI). MethodsThis was a single-center, retrospective study of consecutive STEMI patients undergoing PPCI with TA. TA was considered ineffective if, before angioplasty, coronary flow was TIMI <2. Independent predictors of TA failure were assessed by logistic regression, and predictors of cumulative mortality were assessed by Cox regression analysis. ResultsOf 574 patients, TA was used in 417 (72.6%), and was effective in 365 (87.5%) and ineffective in 52 (12.5%). On multivariate analysis, SYNTAX score (OR=1.049, 95% CI: 1.015–1.084, p=0.005) and total ischemic time (OR=1.001, 95% CI: 1.000–1.003, p=0.02) were independent predictors of TA failure. Moderate or severe left ventricular dysfunction (HR=6.256, 95% CI: 1.896–20.644, p=0.003), APPROACH score (HR=1.094, 95% CI: 1.016–1.177, p=0.017), Killip class III/IV (HR=2.953, 95% CI: 1.122–7.770, p=0.028) and creatinine clearance on admission (HR=0.973, 95% CI: 0.953–0.994, p=0.011) were independently related to cumulative mortality at 24±0.82 months. ConclusionsTotal ischemic time and SYNTAX score were independent predictors of TA failure. However, in medium-term follow-up, ineffective manual TA was not independently related to cumulative mortality." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosO benefício da trombectomia aspirativa manual (TbA) na reperfusão do enfarte de miocárdio com elevação de ST (EAMST) tem sido muito debatida. Na maioria das séries, a ineficácia da TbA tem sido pouco evidenciada. Os nossos objetivos visaram conhecer a taxa, os preditores e o impacto na mortalidade cumulativa da TbA ineficaz (TbANE) numa série de doentes submetidos a intervenção coronária percutânea primária (ICPP). MétodosEstudo retrospetivo, unicêntrico, consecutivo, de doentes com EAMST submetidos a ICPP com TbA. Considerou-se TbANE se após a TbA e antes de prosseguir a angioplastia se se obtivesse fluxo coronário TIMI<2. Identificaram-se preditores independentes de TbANE por regressão logística multivariada. Os preditores de mortalidade cumulativa foram identificados por modelo de Cox. ResultadosDentre 574 doentes, utilizou-se a TbA em 417 (72,6%), que foi eficaz em 365 (87,5%), ineficaz em 52 (12,5%). Na análise multivariada, o score SYNTAX (OR=1,049, 95% CI: 1,015-1,084, p=0,005) e o tempo isquémico total (OR=1,001, 95% CI: 1,000-1,003, p=0,02) foram os preditores independentes de TbANE. A disfunção ventricular esquerda moderada/severa (HR=6,256, 95% CI: 1,896-20,644, p=0,003), o score APPROACH (HR=1,094, 95% CI: 1,016-1,177, p=0,017), a classe 3-4 de Killip (HR=2,953, 95% CI: 1,122-7,770, p=0,028) e a clearance da creatinina na admissão (HR=0,973, 95% CI: 0,953-0,994, p=0,011), relacionaram-se de forma independente com a mortalidade cumulativa (24±0,82 meses). ConclusõesO tempo de sintomas e o score SYNTAX foram preditores independentes de TbANE. Contudo, a TbANE não teve impacto independente com a mortalidade cumulativa a médio prazo." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Luz A, Rodrigues P, Sousa MJ, et al. A trombectomia aspirativa na reperfusão do enfarte agudo de miocárdio: preditores e impacto clínico da sua ineficácia. Rev Port Cardiol. 2014;33:753–760." ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "List of abbreviations" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:10 [ 0 => array:2 [ "termino" => "APPROACH" "descripcion" => "Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease" ] 1 => array:2 [ "termino" => "CMR" "descripcion" => "cardiac magnetic resonance" ] 2 => array:2 [ "termino" => "CrCl" "descripcion" => "creatinine clearance" ] 3 => array:2 [ "termino" => "GRACE" "descripcion" => "Global Registry of Acute Coronary Events" ] 4 => array:2 [ "termino" => "LVEF" "descripcion" => "left ventricular ejection fraction" ] 5 => array:2 [ "termino" => "PPCI" "descripcion" => "primary percutaneous coronary intervention" ] 6 => array:2 [ "termino" => "STEMI" "descripcion" => "ST-elevation myocardial infarction" ] 7 => array:2 [ "termino" => "SYNTAX" "descripcion" => "Synergy between PCI with TAXUS drug-eluting stent and cardiac surgery" ] 8 => array:2 [ "termino" => "TA" "descripcion" => "thrombus aspiration" ] 9 => array:2 [ "termino" => "TIT" "descripcion" => "total ischemic time" ] ] ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1535 "Ancho" => 1660 "Tamanyo" => 88601 ] ] "descripcion" => array:1 [ "en" => "Cumulative survival curves as a function of thrombus aspiration efficacy. TA: thrombus aspiration." ] ] 1 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ACE: angiotensin-converting enzyme; ARBs: angiotensin II receptor blockers; CCBs: calcium channel blockers; CrCl: creatinine clearance; IQR: interquartile range; SD: standard deviation; TA: thrombus aspiration." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Effective TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ineffective TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Demographic and clinical characteristics</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years (± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.69±13.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.65±12.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.129 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">274 (75.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.991 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 (24.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.991 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 (23.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (31.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.229 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypercholesterolemia (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">204 (56.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (49.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.345 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">210 (57.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (52.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.446 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">211 (58.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index, kg/m2 (± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.48±3.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.69±3.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.692 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous infarction (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-infarction angina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (35.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (35.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.962 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CrCl, ml/min (± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.44±35.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.43±40.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.264 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin, mg/dl (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.4 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.9 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.083 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current medication</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Beta-blockers (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.659 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Statins (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.542 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACE inhibitors (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (16.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (12.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.384 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ARBs (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (18.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.917 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CCBs (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.050 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspirin (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (14.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.754 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clopidogrel (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.707 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Insulin (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral antidiabetics (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.929 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrates (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.082 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral anticoagulants (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (9.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.631 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk scores</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GRACE (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">213.0 (45.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">221.0 (54.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TIMI (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.090 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Killip class III/IV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (21.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab634562.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and clinical characteristics, medication and risk scores." ] ] 2 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Effective TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ineffective TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Times to reperfusion, min</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TIT (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">210.0 (248.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">332.5 (393.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Door-to-balloon time (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.0 (70.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.0 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.095 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP, mmHg (± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120±25.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115±30.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.209 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Culprit artery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterior descending (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">156 (42.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (48.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Circumflex (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right coronary (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">165 (45.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (42.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left main (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radial access (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">182 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (56.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.426 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gp IIb/IIIa inhibitors (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 (33.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (38.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.530 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IABP (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (11.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of stent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drug-eluting (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">202 (55.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (48.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bare-metal (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 (41.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Balloon only (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angiographic scores</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SYNTAX (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.5 (10.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (14.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Modified APPROACH (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5 (15.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.963 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCI in other vessels (%)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 (20.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (14.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.313 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab634561.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Percutaneous coronary intervention in non-culprit vessels during the same hospitalization. Gp: glycoprotein; IABP: intra-aortic balloon pump; IQR: interquartile range; PCI: percutaneous coronary intervention; SBP: systolic blood pressure; SD: standard deviation; TA: thrombus aspiration; TIT: total ischemia time." ] ] ] "descripcion" => array:1 [ "en" => "Procedure-related variables." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Effective TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ineffective TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak CK, U/l (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2160.0 (2622.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2143.0 (3138.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.633<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak CK-MB, U/l (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">218.5 (201.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200.0 (219.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.091<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak TnT, ng/ml (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.12 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.64 (5.82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.500<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No reflow (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (35.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEF (n=395) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.164 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preserved/mild dysfunction (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">217 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (52.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate/severe dysfunction (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (47.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Killip class III/IV during hospitalization (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (21.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In-hospital mortality (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (6.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (13.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.073 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median hospital stay, days (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (7.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medication at discharge (n=388)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Beta-blockers (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">322 (93.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (88.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.222 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACE inhibitors/ARBs (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">255 (74.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (77.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.590 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Statins (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">336 (97.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (93.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.121 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspirin (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">343 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clopidogrel (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">343 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab634563.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "p value calculated by the t test for independent samples after logarithmic transformation of CK, CK-MB and TnT. 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Original Article

Thrombus aspiration for reperfusion in myocardial infarction: Predictors and clinical impact of ineffectiveness

A trombectomia aspirativa na reperfusão do enfarte agudo de miocárdio: preditores e impacto clínico da sua ineficácia

André Luz

Corresponding author

andrecoimbraluz@hotmail.com

Corresponding author.

, Patrícia Rodrigues, Maria João Sousa, Inês Silveira, Diana Anjo, Bruno Brochado, Mário Santos, João Silveira, Henrique Cyrne Carvalho, Severo Torres

Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction and Objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">The benefit of manual thrombus aspiration &#40;TA&#41; as an adjunctive technique in the reperfusion of patients with ST-elevation myocardial infarction &#40;STEMI&#41; has been hotly debated&#46; The advantage of TA during primary percutaneous coronary &#40;PPCI&#41; is that it reduces the risk of distal embolization of thrombotic material during the procedure&#44; thus improving microvascular perfusion and reducing infarct size&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;6</span></a> Compared to mechanical thrombus removal&#44; manual TA is simpler to perform and is of equal or superior efficacy&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par8125" class="elsevierStylePara elsevierViewall">The introduction of manual TA aroused great interest and it is now widely used in interventional cardiology&#59; it has a class IIa recommendation&#44; level of evidence B&#44; in the European Society of Cardiology guidelines for the management of STEMI&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Nevertheless&#44; there is considerable variation in use of this technique as adjunctive therapy to reperfusion&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In a recent survey&#44; manual TA was used in less than 20&#37; of PPCI procedures in the US&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Although some randomized studies have demonstrated clinical benefit by reducing major cardiovascular events&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> subsequently confirmed in meta-analyses&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;16&#8211;18</span></a> other series&#44; including one large-scale study&#44; have not shown the same clinical efficacy&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;22</span></a> However&#44; TA may not be possible in some cases &#40;10&#37; of patients scheduled for TA in the TAPAS study<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#41;&#46; The effect of failure of TA in patients in whom it was considered to be indicated has been largely unreported&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The primary objective of this study was to identify the predictors of TA failure in a consecutive series of STEMI patients referred for PPCI&#44; in which TA was systematically used as the first option &#40;bail-out procedures were excluded&#41;&#46; The secondary objective was to assess the impact of failed TA on cumulative mortality &#40;cardiac and non-cardiac&#41; in the medium term&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population and definitions</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a single-center retrospective study of consecutive STEMI patients admitted for PPCI between January 2008 and December 2013&#46; Patients undergoing coronary artery bypass grafting were excluded&#46; Clinical&#44; laboratory and procedural data from admission to discharge were collected from hospital records&#46; The vital status of patients during follow-up was assessed by consulting medical records or contact with the attending physician&#44; the patient or relatives&#46; The diagnosis of STEMI was based on clinical criteria&#44; together with the following ECG alterations&#58; ST-segment elevation of &#8805;0&#46;15 mV in V2-V3 or of &#8805;0&#46;1 mV in at least two other leads&#44; ST depression of &#8805;0&#46;15 mm in V2-V3 with positive T wave &#40;posterior infarction&#41;&#44; or new-onset complete left bundle branch block&#46; Only patients undergoing manual TA for a documented thrombus in an epicardial coronary artery and TIMI flow 0 or 1 were included in the study&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">No reflow was considered present if after angioplasty distal coronary flow was TIMI &#60;2&#44; or TIMI 2&#8211;3 with no contrast perfusing the myocardial capillary territory &#40;myocardial perfusion grade 0&#41;&#44; or if&#44; after perfusion&#44; stagnation of contrast was observed &#40;myocardial perfusion grade 1&#41;&#44; in the absence of spasm&#44; dissection&#44; or epicardial coronary thrombus&#44; that persisted after intracoronary administration of nitroglycerin and adenosine&#46; TA was considered ineffective if&#44; before angioplasty &#40;balloon and&#47;or stent&#41;&#44; coronary flow was TIMI &#60;2 and effective with TIMI 2&#8211;3&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Total ischemic time &#40;TIT&#41; was defined as the delay between symptom onset &#40;intense&#44; persistent chest pain&#41; and introduction of the guidewire for PPCI&#46; Creatinine clearance &#40;CrCl&#41; was calculated using the Cockcroft-Gault formula&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All patients were risk stratified using the GRACE scores<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> for in-hospital and six-month mortality and the TIMI risk score for STEMI&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The complexity of coronary artery disease was classified using the on-line calculator for the SYNTAX score&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> version 2&#46;11&#44; all lesions with &#62;50&#37; stenosis in vessels of &#62;1&#46;5 mm being included in the analysis&#46; The culprit artery was defined as the one occluded within the previous three months&#46; The area of myocardium at risk was calculated using the modified APPROACH score&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> an angiographic score that estimates the proportion of myocardium that is supplied by a coronary segment based on vessel dominance and caliber&#46; This score is easy to calculate and correlates well with the area at risk as assessed by cardiac magnetic resonance &#40;CMR&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> For example&#44; for the proximal anterior descending artery&#44; the area at risk is estimated at 47&#46;75&#37; if there is a large diagonal vessel downstream of the occlusion and at 41&#46;25&#37; if the diagonal is small or nonexistent&#46; The angiographic analyses were performed by two senior interventional cardiologists&#59; in doubtful cases&#44; the scores were arrived at by consensus or taken as the mean of the individual observations&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Left ventricular ejection fraction &#40;LVEF&#41; was assessed by two-dimensional echocardiography &#40;Philips iE33&#44; Eindhoven&#44; The Netherlands&#41; by Simpson&#39;s method&#46; LVEF was considered preserved if &#8805;55&#37;&#44; mildly depressed if &#8805;45&#37; and &#60;55&#37;&#44; moderately depressed if &#8805;30&#37; and &#60;45&#37;&#44; and severely depressed if &#60;30&#37;&#46; For the purposes of the statistical analysis&#44; LVEF was classified as preserved or mild dysfunction and moderate or severe dysfunction&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Overall cumulative mortality &#40;cardiac and non-cardiac&#44; in-hospital and during follow-up&#41; was considered a major cardiovascular event&#46; Only patients with a follow-up of &#8805;12 months after STEMI were included in the analysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure and medication</span><p id="par0050" class="elsevierStylePara elsevierViewall">All patients were medicated with aspirin 300 mg and clopidogrel 600 mg prior to PPCI unless they were already taking these drugs&#46; A 6F or 7F introducer was used&#46; Unfractionated heparin &#40;70 U&#47;kg&#41; was administered during the procedure&#46; Use of glycoprotein IIb&#47;IIIa inhibitors and selection of type of stent and other adjunctive devices were at the operator&#39;s discretion&#46; Manual TA was performed using a 6F Export aspiration catheter &#40;Medtronic&#44; Minneapolis&#44; MN&#44; USA&#41; in all cases&#46; Following PPCI&#44; patients were admitted to the coronary care unit&#46; Myocardial necrosis markers &#40;troponin T &#91;TnT&#93;&#44; creatine kinase &#91;CK&#93; and CK-MB&#41; were measured at 6&#44; 12&#44; 24 and 48 h after reperfusion&#46; All patients were prescribed aspirin 100 mg&#47;day and clopidogrel 75 mg&#47;day at discharge&#44; together with other medication considered appropriate according to the guidelines&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The Kolmogorov-Smirnov test was used to assess the normality of distribution of continuous variables&#44; which were expressed as means &#177; standard deviation or interquartile range for those with normal and non-normal distribution&#44; respectively&#46; Variables with normal distribution were compared by the Student&#39;s t test for independent samples&#44; while those with non-normal distribution were compared by the Mann-Whitney test&#46; Categorical variables were expressed as frequencies and percentages and compared by the chi-square test or by Fisher&#39;s exact test&#46; Peak TnT&#44; CK and CK-MB were logarithmically transformed for parametric tests&#46; A logistic regression model was used to identify predictors of TA failure with failed TA as a dependent variable&#46; Unadjusted mortality according to TA efficacy was calculated using the Kaplan-Meier method&#44; the difference being obtained by the log rank test&#46; Cumulative mortality adjusted for confounding variables was assessed using a Cox model&#46; Variables with p&#60;0&#46;1 on univariate analysis were included in the multivariate analysis in order to identify independent predictors&#46; In order to avoid overadjustment&#44; the GRACE and TIMI scores were not included in the regression analysis&#46; A two-tailed p value of p&#60;0&#46;05 was considered significant&#46; The statistical analysis was performed using SPSS version 20 &#40;SPSS&#44; Chicago&#44; IL&#44; US&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of a total of 614 patients with STEMI&#44; 40 were excluded due to lack of data&#46; Of the 574 assessed&#44; TA was used in 417 &#40;72&#46;6&#37;&#41;&#44; and was effective in 365 &#40;87&#46;5&#37;&#41; and ineffective in 52 &#40;12&#46;5&#37;&#41;&#46; In the latter group&#44; the lesion could not be crossed in four cases &#40;4&#47;52&#44; 7&#46;7&#37;&#41;&#59; the operator proceeded to balloon dilatation of the lesions&#44; but TA was attempted again in only one of these patients&#44; which was also unsuccessful&#46; <a class="elsevierStyleCrossRefs" href="#tbl0020">Tables 1 and 2</a> summarize the clinical and procedure-related characteristics&#44; respectively&#44; of the study population&#44; according to the efficacy of TA&#46; TA failure was significantly associated with non-smokers&#44; higher GRACE and SYNTAX scores and Killip class at admission&#44; and longer TIT&#46; With regard to the procedure&#44; the circumflex was less frequently the culprit artery&#44; and an intra-aortic balloon pump was more frequently used in those with ineffective TA&#46; There was a tendency for a higher rate of previous therapy with nitrates and calcium channel blockers in the ineffective TA group&#44; and lower hemoglobin at admission&#46; In terms of in-hospital outcome &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; the rate of no reflow was higher in those with failed TA&#46; No significant differences were found in peak CK&#44; CK-MB or TnT&#44; or in LVEF at discharge&#44; although it should be noted that enzyme peaks could not be measured in the first 24 h in 21 patients &#40;3&#46;7&#37;&#41;&#44; mainly due to death soon after the procedure &#40;n&#61;19 &#91;90&#46;5&#37;&#93;&#41;&#46; Of these 21 patients&#44; TA was used in 12 &#40;57&#46;1&#37;&#41;&#44; and was effective in seven &#40;58&#46;3&#37;&#41; and ineffective in five &#40;41&#46;7&#37;&#41;&#46; Hospital stay was longer in the ineffective TA group&#46; Mortality was also higher &#40;13&#46;5&#37; vs&#46; 6&#37;&#44; p&#61;0&#46;073&#41; in this group&#44; but without statistical significance&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">On univariate analysis&#44; age&#44; SYNTAX score&#44; current smoking&#44; admission hemoglobin&#44; previous therapy with nitrates or calcium channel blockers&#44; TIT and Killip class III&#47;IV at admission correlated with ineffective TA&#46; In multivariate analysis&#44; only SYNTAX score &#40;odds ratio &#91;OR&#93;&#58; 1&#46;049&#44; 95&#37; confidence interval &#91;CI&#93;&#58; 1&#46;015&#8211;1&#46;084&#44; p&#61;0&#46;005&#41; and TIT &#40;OR&#58; 1&#46;001&#44; 95&#37; CI&#58; 1&#46;000&#8211;1&#46;003&#44; p&#61;0&#46;02&#41; were independent predictors&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We identified 331 patients with at least 12 months of follow-up after STEMI&#46; It was not possible to ascertain vital status in two of these &#40;0&#46;6&#37;&#41;&#44; and so 329 patients were included in the analysis of medium-term mortality &#40;mean follow-up&#58; 24&#177;0&#46;82 months&#44; cumulative mortality rate&#58; 13&#46;9&#37;&#41;&#46; Unadjusted cumulative mortality was higher in the ineffective TA group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; After adjustment for covariables with p&#60;0&#46;1 on univariate analysis &#40;gender&#44; age&#44; TA efficacy&#44; APPROACH and SYNTAX scores&#44; current smoking&#44; TIT&#44; CrCl&#44; target vessel&#44; intra-aortic balloon pump&#44; hemoglobin&#44; systolic blood pressure&#44; Killip class III&#47;IV at admission and LVEF at discharge&#41;&#44; LVEF showing moderate or severe dysfunction &#40;hazard ratio &#91;HR&#93;&#58; 6&#46;256&#44; 95&#37; CI&#58; 1&#46;896&#8211;20&#46;644&#44; p&#61;0&#46;003&#41;&#44; APPROACH score &#40;HR&#58; 1&#46;094&#44; 95&#37; CI&#58; 1&#46;016&#8211;1&#46;177&#44; p&#61;0&#46;017&#41;&#44; and Killip class III&#47;IV &#40;HR&#58; 2&#46;953&#44; 95&#37; CI&#58; 1&#46;122&#8211;7&#46;770&#44; p&#61;0&#46;028&#41; showed a positive correlation with mortality&#44; while higher CrCl values had a protective effect &#40;HR&#58; 0&#46;973&#44; 95&#37; CI&#58; 0&#46;953&#8211;0&#46;994&#44; p&#61;0&#46;011&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In this series&#44; TA was scheduled in the majority of patients &#40;72&#46;6&#37;&#41;&#44; and was effective in most cases &#40;87&#46;5&#37;&#41;&#46; It is plausible that the more organized the thrombus&#44; the less effective TA will be&#44; and it is thus not surprising that the longer the delay between symptom onset and reperfusion&#44; the greater the likelihood of TA failure&#46; The correlation between TIT and thrombus organization as a predictor of adverse events has been reported in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#8211;32</span></a> However&#44; the relationship between SYNTAX score and TA failure is unknown&#46; The technique is more likely to be unsuccessful in patients with unfavorable coronary anatomy such as tortuosity or calcification&#44; or with a large amount of plaque that is at risk of distal embolization&#44; resulting in impaired microvascular perfusion&#46; A correlation between SYNTAX score and risk of no reflow has been demonstrated in some series of patients undergoing PPCI&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Excluding patients in whom TA was not performed&#44; for example because the vessel involved was of small caliber or there was insufficient thrombotic material to justify TA&#44; systematic use of the technique might be expected to reduce infarct size when effective&#46; However&#44; this assumption was not confirmed in our series&#46; Although peak enzyme levels can only estimate infarct size&#44; they correlate well with infarct size as assessed by CMR&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a> In studies using CMR to assess the area of necrosis&#44; patients undergoing TA did not show reduced infarct size&#44;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;36</span></a> even in cases with less microvascular obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">With regard to mortality&#44; no significant differences in clinical endpoints would be expected in view of the small sample size&#46; However&#44; the trend observed in in-hospital mortality could be more marked in larger series&#46; Unsurprisingly&#44; in the patient subgroup assessed for cumulative mortality&#44; LVEF showing moderate to severe dysfunction and Killip class III&#47;IV were strong independent predictors of medium-term mortality&#46; These two parameters&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#8211;39</span></a> together with the area of myocardium at risk&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> have been reported as markers of adverse prognosis&#46; An interesting possibility is that TA may only have a significant impact in patients with large areas of at-risk myocardium&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> but specially designed prospective studies are needed to confirm this hypothesis&#46; Renal failure has often been cited as an independent cause of mortality in STEMI patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a> and so it is to be expected that higher CrCl values are associated with a protective effect&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The debate concerning the benefits of TA in reperfusion is far from consensus&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> The conflicting results of studies published to date may be due to sample sizes being too small to assess clinical endpoints and to different methods of evaluating coronary microvascular perfusion&#46; At the same time&#44; it appears that not all patients benefit to the same extent from TA&#44; reflecting the heterogeneity of STEMI patients&#46; Only large-scale studies or meta-analyses will provide solid evidence on the most important clinical endpoints&#44; and so our results concerning mortality should be interpreted with caution&#46; It is known that patients with no reflow have increased long-term mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> The significant relationship found between no reflow and ineffective TA may be reflected in increased cumulative mortality in larger series&#44; which would enable this association to be studied in more detail&#46; Overall&#44; the results of this observational study are similar to the latest series comparing TA with conventional PPCI&#46; With the exception of a lower rate of no reflow&#44; effective TA did not result in an unequivocal benefit compared to ineffective TA&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Study limitations</span><p id="par0095" class="elsevierStylePara elsevierViewall">Limitations include the fact that this was a single-center retrospective study and with too small a sample size to assess the impact of TA efficacy on medium-term mortality&#46; The rate of TA failure was low &#40;&#60;15&#37;&#41;&#44; which may have affected the results&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">In our series&#44; TA was ineffective in 12&#46;5&#37; of cases&#44; and TIT and SYNTAX score were independent predictors of TA failure&#46; On multivariate analysis&#44; ineffective TA was not related to larger infarct size or increased medium-term mortality&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The benefit of manual thrombus aspiration &#40;TA&#41; in the reperfusion of patients with ST-elevation myocardial infarction &#40;STEMI&#41; has been hotly debated&#46; In most series&#44; failure of TA has been largely unreported&#46; Our objectives were to assess the rate&#44; predictors&#44; and impact on cumulative mortality of failed TA during primary percutaneous coronary intervention &#40;PPCI&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a single-center&#44; retrospective study of consecutive STEMI patients undergoing PPCI with TA&#46; TA was considered ineffective if&#44; before angioplasty&#44; coronary flow was TIMI &#60;2&#46; Independent predictors of TA failure were assessed by logistic regression&#44; and predictors of cumulative mortality were assessed by Cox regression analysis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of 574 patients&#44; TA was used in 417 &#40;72&#46;6&#37;&#41;&#44; and was effective in 365 &#40;87&#46;5&#37;&#41; and ineffective in 52 &#40;12&#46;5&#37;&#41;&#46; On multivariate analysis&#44; SYNTAX score &#40;OR&#61;1&#46;049&#44; 95&#37; CI&#58; 1&#46;015&#8211;1&#46;084&#44; p&#61;0&#46;005&#41; and total ischemic time &#40;OR&#61;1&#46;001&#44; 95&#37; CI&#58; 1&#46;000&#8211;1&#46;003&#44; p&#61;0&#46;02&#41; were independent predictors of TA failure&#46; Moderate or severe left ventricular dysfunction &#40;HR&#61;6&#46;256&#44; 95&#37; CI&#58; 1&#46;896&#8211;20&#46;644&#44; p&#61;0&#46;003&#41;&#44; APPROACH score &#40;HR&#61;1&#46;094&#44; 95&#37; CI&#58; 1&#46;016&#8211;1&#46;177&#44; p&#61;0&#46;017&#41;&#44; Killip class III&#47;IV &#40;HR&#61;2&#46;953&#44; 95&#37; CI&#58; 1&#46;122&#8211;7&#46;770&#44; p&#61;0&#46;028&#41; and creatinine clearance on admission &#40;HR&#61;0&#46;973&#44; 95&#37; CI&#58; 0&#46;953&#8211;0&#46;994&#44; p&#61;0&#46;011&#41; were independently related to cumulative mortality at 24&#177;0&#46;82 months&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Total ischemic time and SYNTAX score were independent predictors of TA failure&#46; However&#44; in medium-term follow-up&#44; ineffective manual TA was not independently related to cumulative mortality&#46;</p>"
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      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O benef&#237;cio da trombectomia aspirativa manual &#40;TbA&#41; na reperfus&#227;o do enfarte de mioc&#225;rdio com eleva&#231;&#227;o de ST &#40;EAMST&#41; tem sido muito debatida&#46; Na maioria das s&#233;ries&#44; a inefic&#225;cia da TbA tem sido pouco evidenciada&#46; Os nossos objetivos visaram conhecer a taxa&#44; os preditores e o impacto na mortalidade cumulativa da TbA ineficaz &#40;TbANE&#41; numa s&#233;rie de doentes submetidos a interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria &#40;ICPP&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo&#44; unic&#234;ntrico&#44; consecutivo&#44; de doentes com EAMST submetidos a ICPP com TbA&#46; Considerou-se TbANE se ap&#243;s a TbA e antes de prosseguir a angioplastia se se obtivesse fluxo coron&#225;rio TIMI&#60;2&#46; Identificaram-se preditores independentes de TbANE por regress&#227;o log&#237;stica multivariada&#46; Os preditores de mortalidade cumulativa foram identificados por modelo de Cox&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Dentre 574 doentes&#44; utilizou-se a TbA em 417 &#40;72&#44;6&#37;&#41;&#44; que foi eficaz em 365 &#40;87&#44;5&#37;&#41;&#44; ineficaz em 52 &#40;12&#44;5&#37;&#41;&#46; Na an&#225;lise multivariada&#44; o <span class="elsevierStyleItalic">score</span> SYNTAX &#40;OR&#61;1&#44;049&#44; 95&#37; <span class="elsevierStyleSmallCaps">CI</span>&#58; 1&#44;015-1&#44;084&#44; p&#61;0&#44;005&#41; e o tempo isqu&#233;mico total &#40;OR&#61;1&#44;001&#44; 95&#37; CI&#58; 1&#44;000-1&#44;003&#44; p&#61;0&#44;02&#41; foram os preditores independentes de TbANE&#46; A disfun&#231;&#227;o ventricular esquerda moderada&#47;severa &#40;HR&#61;6&#44;256&#44; 95&#37; CI&#58; 1&#44;896-20&#44;644&#44; p&#61;0&#44;003&#41;&#44; o <span class="elsevierStyleItalic">score</span> APPROACH &#40;HR&#61;1&#44;094&#44; 95&#37; CI&#58; 1&#44;016-1&#44;177&#44; p&#61;0&#44;017&#41;&#44; a classe 3-4 de Killip &#40;HR&#61;2&#44;953&#44; 95&#37; CI&#58; 1&#44;122-7&#44;770&#44; p&#61;0&#44;028&#41; e a <span class="elsevierStyleItalic">clearance</span> da creatinina na admiss&#227;o &#40;HR&#61;0&#44;973&#44; 95&#37; CI&#58; 0&#44;953-0&#44;994&#44; p&#61;0&#44;011&#41;&#44; relacionaram-se de forma independente com a mortalidade cumulativa &#40;24&#177;0&#44;82 meses&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O tempo de sintomas e o <span class="elsevierStyleItalic">score</span> SYNTAX foram preditores independentes de TbANE&#46; Contudo&#44; a TbANE n&#227;o teve impacto independente com a mortalidade cumulativa a m&#233;dio prazo&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Luz A&#44; Rodrigues P&#44; Sousa MJ&#44; et al&#46; A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;753&#8211;760&#46;</p>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:10 [
              0 => array:2 [
                "termino" => "APPROACH"
                "descripcion" => "<p id="par0125" class="elsevierStylePara elsevierViewall">Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease</p>"
              ]
              1 => array:2 [
                "termino" => "CMR"
                "descripcion" => "<p id="par0130" class="elsevierStylePara elsevierViewall">cardiac magnetic resonance</p>"
              ]
              2 => array:2 [
                "termino" => "CrCl"
                "descripcion" => "<p id="par0135" class="elsevierStylePara elsevierViewall">creatinine clearance</p>"
              ]
              3 => array:2 [
                "termino" => "GRACE"
                "descripcion" => "<p id="par0140" class="elsevierStylePara elsevierViewall">Global Registry of Acute Coronary Events</p>"
              ]
              4 => array:2 [
                "termino" => "LVEF"
                "descripcion" => "<p id="par0145" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>"
              ]
              5 => array:2 [
                "termino" => "PPCI"
                "descripcion" => "<p id="par0150" class="elsevierStylePara elsevierViewall">primary percutaneous coronary intervention</p>"
              ]
              6 => array:2 [
                "termino" => "STEMI"
                "descripcion" => "<p id="par0155" class="elsevierStylePara elsevierViewall">ST-elevation myocardial infarction</p>"
              ]
              7 => array:2 [
                "termino" => "SYNTAX"
                "descripcion" => "<p id="par0160" class="elsevierStylePara elsevierViewall">Synergy between PCI with TAXUS drug-eluting stent and cardiac surgery</p>"
              ]
              8 => array:2 [
                "termino" => "TA"
                "descripcion" => "<p id="par0165" class="elsevierStylePara elsevierViewall">thrombus aspiration</p>"
              ]
              9 => array:2 [
                "termino" => "TIT"
                "descripcion" => "<p id="par0170" class="elsevierStylePara elsevierViewall">total ischemic time</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1535
            "Ancho" => 1660
            "Tamanyo" => 88601
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves as a function of thrombus aspiration efficacy&#46; TA&#58; thrombus aspiration&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ACE&#58; angiotensin-converting enzyme&#59; ARBs&#58; angiotensin II receptor blockers&#59; CCBs&#58; calcium channel blockers&#59; CrCl&#58; creatinine clearance&#59; IQR&#58; interquartile range&#59; SD&#58; standard deviation&#59; TA&#58; thrombus aspiration&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91 &#40;24&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;23&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;31&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypercholesterolemia &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">204 &#40;56&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">210 &#40;57&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;52&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">211 &#40;58&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Body mass index&#44; kg&#47;m<span class="elsevierStyleSup">2</span> &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26&#46;48&#177;3&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">26&#46;69&#177;3&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;692&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Previous infarction &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pre-infarction angina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">129 &#40;35&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;35&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;962&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CrCl&#44; ml&#47;min &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;44&#177;35&#46;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;43&#177;40&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; mg&#47;dl &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;9 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;083&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Current medication</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Beta-blockers &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;659&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Statins &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACE inhibitors &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;384&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ARBs &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;17&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;18&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CCBs &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aspirin &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;754&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clopidogrel &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;707&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insulin &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral antidiabetics &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;929&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nitrates &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral anticoagulants &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;631&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Risk scores</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GRACE &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">213&#46;0 &#40;45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">221&#46;0 &#40;54&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIMI &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;0 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Killip class III&#47;IV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;21&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab634562.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics&#44; medication and risk scores&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            0 => array:2 [
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                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Effective TA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ineffective TA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Door-to-balloon time &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70&#46;0 &#40;70&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;095&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">SBP&#44; mmHg &#40;&#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">115&#177;30&#46;74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;209&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Culprit artery</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anterior descending &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;48&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Circumflex &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right coronary &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">165 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;42&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left main &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Radial access &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">182 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;56&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;426&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gp IIb&#47;IIIa inhibitors &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;026&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Drug-eluting &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;48&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bare-metal &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">151 &#40;41&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;40&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Balloon only &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                            0 => "G&#46; Heusch"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2014.05.007

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Year/Month	Html	Pdf	Total

2024 November	3	6	9
2024 October	37	28	65
2024 September	47	25	72
2024 August	55	30	85
2024 July	45	28	73
2024 June	33	24	57
2024 May	45	24	69
2024 April	29	24	53
2024 March	51	16	67
2024 February	39	25	64
2024 January	20	19	39
2023 December	22	33	55
2023 November	22	16	38
2023 October	22	23	45
2023 September	15	17	32
2023 August	20	19	39
2023 July	21	8	29
2023 June	27	19	46
2023 May	30	21	51
2023 April	16	5	21
2023 March	29	20	49
2023 February	24	22	46
2023 January	22	5	27
2022 December	39	16	55
2022 November	45	24	69
2022 October	21	15	36
2022 September	22	30	52
2022 August	27	35	62
2022 July	38	26	64
2022 June	21	20	41
2022 May	23	22	45
2022 April	23	22	45
2022 March	25	21	46
2022 February	26	19	45
2022 January	17	18	35
2021 December	21	28	49
2021 November	31	35	66
2021 October	25	36	61
2021 September	16	25	41
2021 August	30	29	59
2021 July	12	25	37
2021 June	17	15	32
2021 May	20	22	42
2021 April	32	25	57
2021 March	51	12	63
2021 February	43	12	55
2021 January	33	13	46
2020 December	21	7	28
2020 November	31	12	43
2020 October	22	8	30
2020 September	34	14	48
2020 August	18	7	25
2020 July	43	5	48
2020 June	27	9	36
2020 May	29	4	33
2020 April	27	6	33
2020 March	41	11	52
2020 February	39	62	101
2020 January	26	7	33
2019 December	38	2	40
2019 November	32	7	39
2019 October	40	11	51
2019 September	30	11	41
2019 August	24	8	32
2019 July	35	10	45
2019 June	24	6	30
2019 May	22	5	27
2019 April	20	18	38
2019 March	17	10	27
2019 February	28	11	39
2019 January	23	11	34
2018 December	59	10	69
2018 November	130	19	149
2018 October	271	11	282
2018 September	28	12	40
2018 August	32	8	40
2018 July	17	1	18
2018 June	24	11	35
2018 May	31	10	41
2018 April	35	8	43
2018 March	36	9	45
2018 February	14	2	16
2018 January	28	7	35
2017 December	43	3	46
2017 November	44	11	55
2017 October	35	11	46
2017 September	50	11	61
2017 August	41	11	52
2017 July	24	13	37
2017 June	33	5	38
2017 May	34	19	53
2017 April	29	14	43
2017 March	32	11	43
2017 February	31	6	37
2017 January	25	0	25
2016 December	41	20	61
2016 November	23	6	29
2016 October	35	9	44
2016 September	30	8	38
2016 August	13	1	14
2016 July	16	7	23
2016 June	6	2	8
2016 May	13	5	18
2016 April	23	14	37
2016 March	30	19	49
2016 February	56	25	81
2016 January	34	23	57
2015 December	53	22	75
2015 November	38	17	55
2015 October	36	22	58
2015 September	35	11	46
2015 August	53	16	69
2015 July	44	19	63
2015 June	31	4	35
2015 May	37	17	54
2015 April	44	24	68
2015 March	37	21	58
2015 February	44	25	69
2015 January	115	58	173

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