The benefits of thrombus aspiration after heart attack

SummaryBackground

Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction can be complicated by spontaneous or angioplasty-induced embolisation of atherothrombotic material. Distal blockage induces microvascular obstruction and can result in less than optimum reperfusion of viable myocardium. The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) found that thrombus aspiration resulted in improved myocardial reperfusion compared with conventional PCI, but whether this benefit improves clinical outcome is unknown. We aimed to investigate whether the early efficacy of thrombus aspiration seen in TAPAS translated into clinical benefit after 1 year.

Methods
Patients with ST-elevation myocardial infarction enrolled at the University Medical Centre Groningen were randomly assigned in a 1:1 ratio to either thrombus aspiration or conventional treatment, before undergoing initial coronary angiography. Exclusion criteria were rescue PCI after thrombolysis and known existence of a concomitant disease with life expectancy less than 6 months. Of the 1071 patients enrolled between January, 2005, and December, 2006, vital status at or beyond 1 year after randomisation was available for 1060 (99%). The primary endpoint was cardiac death or non-fatal reinfarction after 1 year, and analysis was by intention to treat. The TAPAS trial is registered with Current Controlled Trials number ISRCTN16716833.

Findings
Cardiac death at 1 year was 3•6% (19 of 535 patients) in the thrombus aspiration group and 6•7% (36 of 536) in the conventional PCI group (hazard ratio [HR] 1•93; 95% CI 1•11–3•37; p=0•020). 1-year cardiac death or non-fatal reinfarction occurred in 5•6% (30 of 535) of patients in the thrombus aspiration group and 9•9% (53 of 536) of patients in the conventional PCI group (HR 1•81; 95% CI 1•16–2•84; p=0•009).

Interpretation
Compared with conventional PCI, thrombus aspiration before stenting of the infarcted artery seems to improve the 1-year clinical outcome after PCI for ST-elevation myocardial infarction.

Funding
Medtronic and the Thorax Centre of the University Medical Centre Groningen.
Affiliations

a. Department of Cardiology, University Medical Centre Groningen, University of Groningen, Netherlands
b. Department of Pathology, University Medical Centre Groningen, University of Groningen, Netherlands
Correspondence to: PJ Vlaar, Department of Cardiology, University Medical Centre Groningen, Thorax Centre, Netherlands

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