Original title: Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction. TASTE trial. Reference: Ole Fröbert et al. N Engl J Med 2013. DOI: 10.1056/NEJMoa1308789
One of the biggest challenges of primary angioplasty is to restore normal coronary flow. Thromboaspiration is a relatively simple, quick and cheap it can improve the flow and resolution of ST , however , the above has not been a universal finding in the randomized works , records or meta-analysis published so far. The TASTE ( Thrombus Aspiration in ST – Elevation Myocardial Infarction in Scandinavia ) was a multicenter , randomized , prospective, controlled study designed to evaluate the effect of thromboaspiration on hard clinical end points in patients suffering an ST segment elevation myocardial infarction. The primary end point was death from any cause at 30 days and the secondary endpoints included 30-day rate of re-infarction , stent thrombosis, target lesion revascularization , target lesion revascularization and a composite of death and myocardial re-infarction .
A total of 7244 patients were randomized 1:1 to manual thromboaspiration versus angioplasty alone. At 30 days 2.8% ( 103 of 3621 ) decease of randomized to thromboaspiration versus 3% (110 of 3623 ) of patients randomized to angioplasty alone ( HR with thromboaspiration, 0.94 CI 95% , 0.72 to 1.22 , P = 0.63 ) . The recurrence rate of re-infarction at 30 days was 0.5 % with thromboaspiration versus 0.9 % with angioplasty alone (HR 0.61 , CI 95 %, 0.34 to 1.07 , P = .09 ).
The rates of stent thrombosis, target vessel revascularization and the injury did not differ significantly between groups. No differences in safety end point as systemic embolism , stroke , perforation or tamponade . The result in the primary end point was consistent across all prespecified subgroups , including those at high risk of thrombosis as those admitted with TIMI 0-1 or those with large amounts of thrombus.
Conclusion:
Routine aspiration compared with angioplasty alone does not reduce mortality at 30-day in patients suffering ST segment elevation myocardial infarction.
Editorial Comment:
Since this analysis was limited to a 30-day follow-up clinical differences may not have been observed and that might be apparent with longer follow-up . Indeed the mortality benefit observed in TAPAS study was observed only after a year . The TAPAS also noted a trend toward higher stroke with thromboaspiration ( this complication if it is expected to happen immediately if was related to thromboaspiration) , however this analysis with many more patients than the TAPAS showed no differences. The simple, quick and inexpensive thromboaspiration added to the absence of adverse effects suggests that monitoring would have to wait longer before leaving this practice.
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