Table 1 Study characteristics

ADMIT [28]

Haifa, Israel

100

I = 57.5 (12.4)

86 (86.0)

Admission <12 hours of onset of symptoms of STEMI, regardless of the initial TIMI flow

Inability to consent; known allergy to either aspirin or clopidogrel; life expectancy <6 months; cardiogenic shock

6 months

Quality of epicardial and microcirculation perfusion; LV function; ischemic mitral regurgitation; MACE (death, recurrent MI, TVR)

C = 57.2 (12.1)

Bulum 2012 [29]

Zagreb, Croatia

60

I = 54.3 (9.7)

47 (78.3)

Symptoms suggesting acute myocardial ischemia of >20 min, time from symptom onset of <12 hours, and ST-segment elevation >0.1 mV in >2 contiguous ECG leads

Need for rescue PCI after failed thrombolysis; cardiogenic shock; triple-vessel disease; significant LMCA stenosis; previous PCI of an IRA; previous CABG; life expectancy <6 months

6 months

Referent vessel diameter; minimal lumen diameter; lesion length; percentage of diameter stenosis; MACE (death, recurrent MI, stroke, TLR)

C = 58.5 (8.6)

Chao 2008 [30]

Taipei City, Taiwan

74

I = 60 (13)

63 (85.1)

STEMI (typical chest pain >30 min with new ST-segment elevation ≥0.1 mV in >2 contiguous leads on a 12-lead ECG), <12 hours after onset, and eligible for primary PCI

Killip IV hemodynamic status; ventricular tachyarrhythmias; previous CABG or significant LMCA lesion; culprit vessel diameter <2 mm; existing TIMI 3 flow without visible thrombus in IRA

6 months

Angiographic differences in TIMI and MBG (post PCI - baseline); MACE (death, stroke, non-fatal recurrent MI, TVR)

C = 62 (11)

De Luca 2006 [31]

Rome, Italy

76

I = 66.7 (14.1)

48 (63.2)

Anterior STEMI, >18 years old, and have an identifiable thrombus on IRA at coronary angiography

Previous MI or CABG; triple-vessel disease; severe valvar disease; TIMI 2 or 3 flow at the time of initial angiography; unsuccessful PCI defined as no antegrade flow or >50 % residual stenosis in the IRA

6 months

LV remodeling; MACE (death, recurrent MI, hospitalization for HF)

C = 64.6 (12.5)

EXPIRA [32, 33]

Rome, Italy

175

I = 66.7 (14.1)

105 (60.0)

First STEMI, <9 hours from symptoms onset, IRA ≥2.5 mm in diameter, thrombus score ≥ 3, TIMI flow ≤1, and >18 years old

Previous PCI on IRA; previous CABG; cardiogenic shock; triple-vessel disease; LMCA disease; severe valvular disease; thrombolysis; contraindication to glycoprotein IIb/IIIa inhibitors

9 months

Final MBG ≥2; rate of 90-min ST-segment resolution >70 %; MACE (cardiac death, recurrent MI, TVR); stent thrombosis

C = 64.6 (12.5)

EXPORT [34]

24 centres in India and Europe

249

I = 59.2 (12.8)

202 (81.1)

>18 years old, STEMI <12 hours of symptom onset, ST-segment elevation ≥2 mm in ≥2 contiguous leads, visual reference vessel diameter >2.5 mm, and with TIMI flow of 0 or 1 before placing the wire in the IRA

Cardiogenic shock; cardiac arrest prior to intervention; pre-catheterization therapy with lytic agents, or with glycoprotein IIb/IIIa inhibitors, or with pacemakers; life expectancy <1 year; current participation in other investigations

1 month

Reperfusion (rate of ST-segment resolution >50 % at 60 minutes postprocedure or MBG 3 immediately postprocedure); magnitude of ST-segment resolution; improvement in TIMI flow; corrected TIMI frame count; MACE (death, recurrent MI, emergent CABG, TLR or TVR, stroke); rate of distal embolization; rate of required bailout techniques (rescue use of the aspiration catheter, distal protection, or glycoprotein IIb/IIIa inhibitors)

C = 61.2 (12.9)

IMPACT [35]

Cambridge, UK

56

I = 64.9 (11.2)

C = 67.2 (11.6)

31 (55.3)

>18 and <90 years old, ability to give informed consent, STEMI (ST-segment elevation ≥2 mm in ≥2 contiguous chest leads or ≥1 mm in ≥2 contiguous limb leads) or new LBBB, chest pain for <12 hours, restoration of at least TIMI 1 flow after the wire crossed the occlusion

Cardiogenic shock; previous MI in the IRA territory; unfavourable anatomy (LMCA occlusion or distal vessel occlusion); severe asthma or bradycardia precluding use of adenosine; women of childbearing age; life expectancy <3 months

6 months

Index of microcirculatory resistence; MACE (all-cause death or MI)

INFUSE-AMI [36, 37]

37 sites in 6 countries

452

I = 61 (NR)

334 (73.9)

≥18 years old, STEMI with ≥1 mm of ST-segment elevation in ≥2 contiguous leads in V1 through V4 or new LBBB with anticipated symptom onset to device time of ≤5 hours

Prior MI, CABG or LAD stenting; contraindications to study medications, contrast or CMRI; creatinine clearance <30 mL/min per 1.73 m² or dialysis; platelet count <100,000 or >700,000 cells/mm³; hemoglobin <10 g/dL; recent major bleeding; bleeding diathesis; current warfarin use; intracranial disease, stroke or TIA within 6 months or any neurological defect; cardiogenic shock; prior fibrinolysis or glycoprotein IIb/IIIa inhibitors for the present admission; any comorbid likely to interfere with protocol compliance or associated with <1 year survival

12 months

Infarct size measured as a percentage of LV mass at 30 days. MACE (death, recurrent MI, new-onset severe HF, re-hospitalization for HF, stroke, clinically driven TVR)

C = 60 (NR)

ITTI [38]

Kaohsiung City, Yun-Lin Branch, Taiwan

100

I = 60.4 (11.9)

86 (86.0)

≥18 years old, continuous

chest pain ≥30 min, ST-segment elevation >0.1 mV in ≥2 contiguous leads on a 12-lead ECG

Cardiogenic shock (systolic BP > 80 mmHg or need for inotropic agent); history of bleeding tendency, major operation within 6 weeks; hepatic or renal insufficiency; contraindication to tirofiban use

6 months

Occurrence of MBG 3; complete ST-segment resolution; procedure time; occurrence of no-reflow; CK-MB peak and time to peak; TIMI flow and corrected TIMI frame count; MACE (death, recurrent MI, TLR, stroke)

C = 56.5 (11.9)

Kaltoft 2006 [39]

Aarhus, Denmark

215

I = 65 (11)

168 (78.1)

STEMI, symptoms lasting >30 min but <12 hours, and cumulative ST-segment elevation of ≥2 mV in ≥2 contiguous leads

LBBB; MI within the previous 30 days; fibrinolytic treatment; previous CABG; LCA stenosis; need for mechanical ventilation; severe HF treated with intra-aortic balloon pump

1 month

Myocardial salvage estimated by 99mTc-sestamibi SPECT; final infarct size; markers of effective reperfusion (TIMI flow, corrected TIMI frame count, ST-segment resolution immediately, 90 min and 6 hours after PCI); release of TnT; distal embolization visible at the end of PCI; total procedure time; MACE (death, recurrent MI, disabling stroke); LVEF after 30 days; technical success of the thrombectomy

C = 63 (13)

Liistro 2009 [40]

Arezzo, Italy

111

I = 64 (11)

86 (77.5)

STEMI with symptoms lasting >30 minutes and <12 hours, ST-segment elevation >0.1 mV in ≥2 leads on the ECG

Contraindication to the use of platelet glycoprotein IIb/IIIa inhibitors; rescue PCI after thrombolysis; previous MI; absence of optimal echocardiographic apical view; life expectancy <6 months; lack of informed consent

6 months

Rate of ST-segment resolution ≥70 %; TIMI 3 grade flow; corrected TIMI frame count; myocardial contrast echocardiography score index; absence of persistent ST-segment deviation; time course of wall-motion score index; LVEF; LV volume; death; recurrent MI; LV failure; new revascularization

C = 65 (11)

REMEDIA [41]

Rome, Italy

99

I = 61 (13)

83 (83.3)

<12 hours of onset of STEMI referred for primary or rescue PCI

No angiographic exclusion criteria were adopted

1 month

MBG ≥2; rate of ST-segment resolution ≥70 %; peak CK-MB; direct stenting rate; distal embolization rate (abrupt “cutoff” occlusion of a distal branch); composite of distal embolization, slow-flow (TIMI flow grade 2), no-reflow (TIMI flow grade 0 to 1); death; recurrent MI; stroke; TLR; any major adverse event

C = 60 (13)

Shehata 2014 [25]

Cairo, Egypt

100

I = 60.32 (9.2)

64 (64)

Diabetic patients suffering from acute STEMI, symptoms lasting >30 minutes and <12 hours before admission, and ST-segment elevation of >0.1 mV in ≥2 leads

Need for rescue PCI after thrombolysis; prior history of unstable angina or MI; prior PCI CABG; congenital heart disease or any myocardial disease apart from ischemia; limited life expectancy due to coexistent disease

8 months

In-stent restenosis (angiographic luminal diameter stenosis by >50 % in quantitative coronary angiography); MACE (death due to cardiac cause, nonfatal MI, TLR)

C = 59.4 (7.4)

Sim 2013 [42]

Gwangju, Republic of Korea

86

I = 63 (NR)

59 (71.1)

STEMI with onset of symptoms <12 hours, coronary artery lesions with visible thrombus, ability to undergo a complete CCT examination (Killip I and II) with the ability to perform a15-second breath-hold

Previous MI or CABG; cardiogenic shock; LMCA disease; severe valvular heart disease; unsuccessful PCI (post-PCI TIMI flow <2 or ≥50 % residual stenosis in IRA); rescue or facilitated PCI; contraindication to glycoprotein IIb/IIIa inhibitors

12 months

Infarct size at 2 months; markers of myocardial reperfusion (TIMI flow, MBG, ST-segment resolution rate at 90 min); LV function and volumes at 2 months; MACE (cardiac death, MI, TVR)

C = 60(NR)

TAPAS [43, 44]

Groningen, The Netherlands

1071

I = 63 (13)

755 (70.5)

STEMI, symptoms >30 minutes and <12 hours, and ST-segment elevation of ≥0.1 mV in ≥2 leads

Rescue PCI after thrombolysis; life expectancy <6 months; lack of informed consent

1 month

Rate of post-procedural MBG of 0; rate of TIMI flow grade of 3; complete resolution of ST-segment elevation; absence of persistent ST-segment deviation; TVR; recurrent MI; death

C = 63 (13)

TASTE [26, 27]

29 centers in Sweden, 1 center in Iceland and 1 in Denmark

7244

I = 66.5 (11.5)

5424 (74.9)

STEMI, chest pain for >30 minutes and <24 hours, ST-segment elevation in ≥2 contiguous leads (≥0.2 mV in lead V2 or V3 or ≥0.1 mV in other leads) or a presumably new LBBB, and a corresponding culprit-artery lesion on angiography

Need for emergency CABG; inability to provide oral informed consent; <18 years old; previously randomized in the study

12 months

MACE (all-cause mortality; rehospitalization for MI; stent thrombosis); TVR; TLR; complications of PCI, stroke or neurologic complications, HF and length of stay during index hospitalization

C = 65.9 (11.7)

TOTAL [6]

87 hospitals in 20 countries

10732

I = 61.0 (11.8)

7797 (72.6)

Symptoms of MI lasting for ≥30 min, definite ECG changes indicating STEMI, referred for PCI for presenting symptoms, randomized within 12 hours of symptoms onset and before diagnostic angiography, Informed consent

≤18 years old; prior CABG; life expectancy <6 months due to noncardiac condition; treatment with fibrinolytic therapy for qualifying index STEMI event

6 months

MACE (cardiovascular death, recurrent MI, cardiogenic shock, HF NYHA class IV); stroke

C = 65.0 (11.9)

TROFI [45, 46]

5 european centres

141

I = 61.1 (11.8)

102 (72.3)

≥18 years old, STEMI documented with ≥2 mm ST-segment elevation in ≥2 contiguous leads prior to PCI, presenting in the cath lab <12 hours after the onset of symptoms lasting ≥20 min and having an angiographically visible stenosis (>30 %) or TIMI ≤ II in a single de novo, native, previously unstented vessel

Pregnancy; known intolerance to aspirin, clopidogrel, heparin, stainless steel, limus drugs, contrast material; diameter stenosis <30 % in the target lesion; multi-vessel CAD; unprotected LMCA stenosis >30 %; distal vessel occlusion; severe tortuous, calcified or angulated anatomy that would result in sub-optimal imaging or excessive risk of complication from insertion of catheter; fibrinolysis prior to PCI; platelet <100,000 cells/μl; coagulopathy or active bleeding or chronic anticoagulation therapy; cardiogenic shock; significant comorbidities precluding follow-up as judged by investigators; major planned surgery requiring discontinuation of antiplatelets; proximal RCA stenosis (>30 %) if the IRA is mid or distal-RCA

12 months

Minimum flow area immediately after PCI assessed by OFDI; MACE (cardiac death, recurrent MI in the territory of IRA, clinically driven TVR)

C = 60.9 (12.7)

VAMPIRE [47]

23 hospitals in Japan

355

I = 63.2 (10.6)

281 (79.1)

≥21 years old, STEMI symptom >30 min but <24 hours, ST-segment elevation ≥2 mm in ≥2 contiguous leads or with a presumably new LBBB

Primary thrombolysis prior to randomization; cardiogenic shock; history of cardiac arrest; history of CABG; chronic renal failure (Cr >2.0 mg/dl) or hemodialysis; LMCA disease; target vessel <2.5 mm or >5 mm in diameter

8 months

Incidence of slow flow or no reflow during primary PCI (TIMI flow grade <3 not attributable to dissection, occlusive thrombus, or epicardial spasm); coronary flow and myocardial perfusion immediately after PCI (assessed by TIMI flow grade, corrected TIMI frame count and MBG); magnitude of ST-segment resolution, peak CK and CK-MB; angiographic in-stent late lumen loss; LV function; brain natriuretic peptide; MACE (death, recurrence MI, TLR)

C = 63.5 (9.9)

Yin 2011 [48]

Dalian, China

164

I = 63.1 (12.9)

120 (73.2)

STEMI patients who had PCI

Not reported

12 months

Thrombus score; periprocedural no-reflow; TIMI frame count; lumen diameter; stent length; 1-week post-procedural ejection fraction; post-procedural angina; recurrent MI; death

C = 62.9 (9.5)