• Cardiology Clinical Trials
• Interventional Techniques & Devices
• Myocardial Infarction

• Cardiology Clinical Trials
• Interventional Techniques & Devices
• Myocardial Infarction
• Cardiology

Thrombus aspiration with percutaneous coronary intervention (PCI) did not improve mortality compared with PCI alone in patients with ST-elevation myocardial infarction (STEMI) in a large, randomized trial. Ole Fröbert, MD, PhD, Örebro University Hospital, Örebro, Sweden, presented data from the Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia trial [TASTE; Fröbert O et al. N Engl J Med 2013].

Coronary artery thrombus aspiration performed in conjunction with PCI has been inconsistently demonstrated to improve blood flow and ST-segment elevation in patients with STEMI. The purpose of the TASTE trial was to evaluate the impact of thrombus aspiration in conjunction with PCI in patients with STEMI.

In the multicenter, prospective, registry-based TASTE trial, 7244 patients with STEMI were randomized to receive manual thrombus aspiration followed by PCI or PCI only. Patients with STEMI were eligible if they experienced symptoms for >30 minutes and <24 hours and STEMI or left bundle-branch block was confirmed on the electrocardiogram. Exclusion criteria were limited to age <18 years, previous randomization in the TASTE trial, and requirement for emergency coronary artery bypass grafting. The primary endpoint was time to all-cause mortality at Day 30. Secondary endpoints included time to rehospitalization with reinfarction at 30 days and time to stent thrombosis at 30 days. Prespecified analyses were performed in the intention-to-treat (ITT) population as well as a per-protocol population among those who received the actual treatment.

The time from symptom onset to PCI was similar among both treatment arms with a mean of ∼180 minutes. In the PCI plus thrombus aspiration arm, the cumulative risk of all-cause mortality was 2.8% compared with 3.0% in the PCI-only arm (HR, 0.94; 95% CI, 0.72 to 1.22; p=0.63) in the ITT analysis and (HR, 0.88; 95% CI, 0.66 to 1.17; p=0.38) in the per-protocol analysis [Fröbert O et al. N Engl J Med 2013].

The cumulative risk of rehospitalization due to reinfarction was 0.5% in the PCI plus thrombus aspiration arm compared with 0.9% in the PCI-only arm (HR, 0.61; 95% CI, 0.34 to 1.07; p=0.09) [Fröbert O et al. N Engl J Med 2013]. In addition, 0.2% of patients that received thrombus aspiration experienced stent thrombosis, compared with 0.5% of patients that received PCI only (HR, 0.47; 95% CI, 0.20 to 1.02; p=0.06). The rates of stroke, neurologic complications, perforation, tamponade, heart failure, or left ventricular dysfunction at hospital discharge were similar among both treatment arms [Fröbert O et al. N Engl J Med 2013].

Prof. Fröbert stated that, in his opinion, the data from the TASTE trial indicate that thrombus aspiration plus PCI does not reduce number of deaths or rehospitalization in patients with STEMI compared with PCI only. Therefore, Prof. Fröbert suggested that there is likely no place for routine thrombus aspiration in conjunction with PCI in clinical practice.

• © 2013 MD Conference Express®