European Society of Cardiology

European Society of Cardiology

Perspective from Kim Allan Williams, MD
Perspective from Sanjit Jolly, MD, MSc
September 02, 2014
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TASTE: Thrombus aspiration before PCI failed to reduce mortality at 1 year

Perspective from Kim Allan Williams, MD
Perspective from Sanjit Jolly, MD, MSc
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BARCELONA, Spain — Among patients with STEMI, routine thrombus aspiration before PCI did not affect all-cause mortality at 1 year when compared with PCI alone, according to data presented here.

Thirty-day results from the TASTE trial were initially presented at ESC Congress 2013 and showed that the primary endpoint of all-cause mortality did not differ for patients treated with routine thrombus aspiration followed by PCI vs. PCI alone.

Recently, the European Society of Cardiology changed its recommendation for thrombus aspiration from a class IIa recommendation to a class IIb recommendation, according to Bo Lagerqvist, MD, PhD.

“This means that selected patients [with MI] could be considered for the treatment,” Lagerqvist, with Uppsala Clinical Research Center, Uppsala, Sweden, said during a press conference. “The evidence grade is also upgraded from ‘B’ to ‘A.’ Most of this [decision-making was] based on the TASTE 30-day results.”

In the analysis presented here at ESC Congress, Lagerqvist and fellow TASTE investigators looked at the impact of both strategies on 1-year all-cause mortality, the prespecified secondary endpoint.

The registry-based trial included 7,244 patients with STEMI who were randomly assigned to manual thrombus aspiration and PCI (n=3,621) or PCI alone (n=3,623).

At 1 year, all-cause mortality was reported in 5.3% of patients assigned thrombus aspiration vs. 5.6% of patients assigned PCI only, a difference that did not reach statistical significance (HR=0.94; 95% CI, 0.78-1.15; P=.57). When Lagerqvist and colleagues examined the composite of death from any cause, rehospitalization from MI or stent thrombosis, they also found no significant differences between groups (thrombus aspiration, 8% vs. PCI only, 8.5%; HR=0.94; 95% CI, 0.8-1.11; P=.48).

In addition, rates of rehospitalization for MI (2.7% for both; HR=0.97; 95% CI, 0.73-1.28; P=.81) and stent thrombosis (thrombus aspiration, 0.7% vs. PCI only, 0.9%; HR=0.84; 95% CI, 0.5-1.4; P=.51) were also comparable between the strategies.

According to Lagerqvist, the findings were consistent across all major subgroups, including grade of thrombus burden and coronary flow before PCI.

As a result of these data, Lagerqvist said, “Our recommendation was routine thrombus aspiration should not be recommended for PCI in STEMI for European guidelines.” – by Brian Ellis

For more information:

Lagerqvist B. Hot Line IV. Myocardial Infarction. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Lagerqvist B. N Engl J Med. 2014;doi:10.1056/nejmoa1405707.

Disclosure: Lagerqvist reports no relevant financial disclosures.