The clinical benefit of thrombus aspiration during angioplasty in patients with ST-segment elevation myocardial infarction is uncertain. The purpose of this work was to test if thrombus aspiration reduces mortality.
This was a multicenter, prospective, randomized and controlled study that included patients with ST-segment elevation myocardial infarction within 24 hours of evolution. The catheters used were Eliminate (Terumo), Export (Medtronic) and Pronto (Vascular Solutions). The primary endpoint was mortality at 30 days and the secondary endpoints rehospitalization due to heart attack and stent thrombosis at 30 days.
The study included 7244 patients randomized to manual thrombus aspiration and angioplasty (3621 patients) or angioplasty (3623 patients). Mortality from all causes occurred in 2.8% of the thrombus aspiration group vs 3% of the group without thrombus aspiration (HR, 0.94; 95% CI, 0.72 – 1.22; p = 0.63). The rate of rehospitalization for heart attack at 30 days was 0.5% vs 0.9% (HR, 0.61; 95% CI, 0.34 – 1.07; p= 0.09) and for stent thrombosis 0.2% vs 0.5% respectively (HR, 0.47; 95% CI, 0.20 – 1.02; p= 0.06). There was no difference between the two groups for stroke.
The results were consistent in all the prespecified groups, including the subgroups according to thrombus burden and initial coronary flow.
Conclusion:
Routine thrombus aspiration before primary angioplasty does not reduce mortality, rehospitalization or stent thrombosis at 30 days compared to angioplasty alone in patients with ST-segment elevation myocardial infarction.
Editorial comment:
According to the guidelines (ACC/AHA/ESC) thrombus aspiration in myocardial infarction is class IIA. A recent publication in Eurointervention showed that only 36% of interventionist cardiologists routinely perform thrombus aspiration. In terms of the negative results, an editorial published in NEJM by Drs. Robert Byrne and Adnan Kastrati emphasizes that the benefit over cardiac remodeling and myocardial recovery may not be evident at 30 days.
Ole Frobert
2013-09-02
Original title: TASTE: Thrombus aspiration during ST-segment elevation myocardial infarction. A multicenter, prospective, registry based randomized clinical trial.
