• Interventional Techniques & Devices
• Thrombotic Disorders
• Cardiology Clinical Trials

• Interventional Techniques & Devices
• Cardiology & Cardiovascular Medicine
• Thrombotic Disorders
• Cardiology Clinical Trials

Aspiration thrombectomy does not improve the extent of microvascular obstruction compared with standard percutaneous coronary intervention (PCI) in patients with non-ST-elevation myocardial infarction (NSTEMI). Holger Thiele, MD, University of Leipzig, Leipzig, Germany, presented data from the Thrombus Aspiration in Thrombus containing culprit lesions in Non-ST-Elevation Myocardial Infarction study [TATORT-NSTEMI; NCT01612312]. The trial protocol has been described in detail by de Waha and colleagues [Trials 2013].

Although the European Society of Cardiology and the American College of Cardiology/American Heart Association guidelines suggest that thrombectomy may be indicated in patients with NSTEMI, [Steg G et al. Eur Heart J 2012; O'Gara PT et al. Circulation 2013] there is currently little data to support its use. The hypothesis of the TATORT-NSTEMI trial is that thrombectomy in patients that have experienced NSTEMI will improve myocardial perfusion and thrombus burden [de Waha S et al. Trials 2013].

In the prospective, randomized, controlled, multicenter, open-label TATORT-NSTEMI trial, 440 NSTEMI patients were randomized in 1:1 fashion to PCI or PCI with adjunctive thrombectomy [de Waha S et al. Trials 2013]. To be eligible for the trial, patients had to have an NSTEMI with >20 minutes of ischemic symptoms that occurred within 72 hours prior to randomization, and identifiable culprit lesions with relevant thrombus (TIMI thrombus Grade 2 to 5). Exclusion criteria included cardiogenic shock, STEMI, unsuitable coronary morphology for thrombectomy, need for coronary artery bypass grafting (CABG), life expectancy <6 months, contraindication to heparin, acetylsalicylic acid, or thienopyridine.

The primary endpoint of the TATORT-NSTEMI trial was microvascular obstruction from Days 1 through 4 as measured by cardiac magnetic resonance imaging [de Waha S et al. Trials 2013]. The secondary endpoints included infarct size, myocardial salvage, the composite of mortality, reinfarction, target vessel revascularization (TVR), and congestive heart failure at 6 months, TIMI-flow post PCI, myocardial blush grade post PCI, and enzymatic infarct size as measured by Troponin T at 24 and 48 hours.

The median age of the participants was 69 years and 68 years in the thrombectomy and standard PCI arms, respectively. Prior MI occurred in 7% and 12% of the patients in the thrombectomy and PCI arms, respectively, and the rates of prior PCI (13%) and CABG (3% vs 5%) were similar among the arms. Most patients had a TIMI thrombus grade of 3 to 5, and the median GRACE score was 145 in the thrombectomy arm and 137 in the PCI arm.

Results of the TATORT-NSTEMI trial demonstrated no significant difference in microvascular obstruction between the thrombectomy and standard PCI arms (p=0.74). In addition, there was no significant difference in the extent of the microvascular obstruction between the treatment arms (p=0.17). Furthermore, there was no significant difference in any of the secondary endpoints, including clinical outcome at 6 months.

Prof. Thiele stated that the data from the TATORT-NSTEMI trial indicate that aspiration thrombectomy did not decrease the extent of microvascular obstruction as measured by cardiac MRI when compared with standard PCI.

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The editors would like to thank the many members of the Transcatheter Cardiovascular Therapeutics presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.

• © 2013 MD Conference Express®