Abstract
BackgroundRoutine thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the “A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI” (TOTAL) trial. We aimed to analyse a similar endpoint in “The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia” (TASTE) trial up to 180 days.MethodsIn TASTE, 7244 patients with STEMI were randomised to thrombus aspiration followed by PCI or to PCI alone. We analysed the quadruple composite endpoint of cardiovascular death, cardiogenic shock, rehospitalisation for myocardial infarction, or new hospitalisation for heart failure. Furthermore, an extended net-benefit composite endpoint including stent thrombosis, target vessel revascularization or stroke within 180 days was analysed.ResultsThe primary quadruple composite endpoint occurred in 8.7 % (316 of 3621) in the thrombus aspiration group compared to 9.3 % (338 of 3623) in the PCI alone group (hazard ratio (HR), 0.93; 95 % confidence interval (CI); 0.80 - 1.09, P = 0.36) and the extended net-benefit composite endpoint in 12.0 % (436) vs. 13.2 % (479) (HR, 0.90; 95 % CI; 0.79 - 1.03, P = 0.12). Stroke within 30 days occurred in 0.7 % (27) vs. 0.7 % (24) (HR, 0.89; 95 % CI; 0.51–1.54, P = 0.68).ConclusionsA large and an extended composite endpoint analysis from the TASTE trial did not demonstrate any clinical benefit of routine thrombus aspiration during PCI in patients with STEMI. There was no evidence of an increased risk of stroke with thrombus aspiration.
Highlights
Routine thrombus aspiration during primary percutaneous coronary intervention (PCI) in stent thrombosis (ST)-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the “A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With ST-elevation myocardial infarction (STEMI) Undergoing Primary PCI” (TOTAL) trial
We wanted to analyse the TASTE cohort of patients, using similar endpoints collected in the TOTAL trial, captured up to 180 days for a composite endpoint of CV death, rehospitalisation for new MI, cardiogenic shock and rehospitalisation for heart failure (HF) and collect data for the key safety outcome of stroke up to 30 and 180 days which has come into question following publication of the TOTAL trial
For efficacy up to 180 days, there were no significant differences in outcome for the individual endpoints of all cause death, CV death, rehospitalisation with new MI, definite ST, and target vessel revascularization (TVR) or in combination with cardiogenic shock or new hospitalisation with HF
Summary
Routine thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the “A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI” (TOTAL) trial. We aimed to analyse a similar endpoint in “The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia” (TASTE) trial up to 180 days. The two largest randomised trials, “The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia” We wanted to analyse the TASTE cohort of patients, using similar endpoints collected in the TOTAL trial, captured up to 180 days for a composite endpoint of CV death, rehospitalisation for new MI, cardiogenic shock and rehospitalisation for HF and collect data for the key safety outcome of stroke up to 30 and 180 days which has come into question following publication of the TOTAL trial
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