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ST-elevation myocardial infarction, thrombus aspiration, and different invasive strategies. A TASTE trial substudy
Ole Fröbert1, Fredrik Calais1, Stefan K James2
1Department of Cardiology, Faculty of Health, Örebro University, Sweden (O.F., F.C.).
Insights
Thrombus aspiration in ST-elevation myocardial infarction did not improve outcomes, regardless of catheter type. Stenting techniques like direct stenting or postdilation also showed no impact on mortality in this trial.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- The clinical benefit of thrombus aspiration in ST-elevation myocardial infarction (STEMI) may be influenced by the specific aspiration catheter and stenting techniques used.
- The TASTE trial initially found no overall clinical benefit of thrombus aspiration compared to percutaneous coronary intervention (PCI) alone in STEMI patients.
Purpose of the Study:
- To assess the impact of different aspiration catheter types on outcomes in STEMI patients randomized to thrombus aspiration.
- To evaluate the influence of stent type, direct stenting, and postdilatation on clinical outcomes in STEMI patients, irrespective of whether they received thrombus aspiration or PCI alone.
Main Methods:
- A multicenter, prospective, randomized, open-label trial (TASTE) involving STEMI patients.
- Analysis of outcomes at 1 year, comparing different aspiration catheters (Eliminate, Export, Pronto) within the thrombus aspiration arm.
- Comparison of mortality rates between patients randomized to thrombus aspiration versus PCI alone, stratified by stenting technique (direct stenting, drug-eluting stents, postdilation).
Main Results:
- No significant difference in all-cause mortality was observed between the three most common aspiration catheters used in the thrombus aspiration group.
- Mortality rates were similar between patients randomized to thrombus aspiration with direct stenting versus those treated with PCI alone.
- No significant differences in mortality were found for patients receiving drug-eluting stents or those treated with postdilation, regardless of the assigned treatment arm.
- Rehospitalization for myocardial infarction and stent thrombosis rates did not differ between the randomized groups across any subgroup.
Conclusions:
- The choice of aspiration catheter does not influence clinical outcomes in STEMI patients randomized to thrombus aspiration.
- Stent type, direct stenting, and postdilation do not impact outcomes in STEMI patients, irrespective of whether they undergo thrombus aspiration with PCI or PCI alone.
Background:
The clinical effect of thrombus aspiration in ST-elevation myocardial infarction may depend on the type of aspiration catheter and stenting technique.
Methods And Results:
The multicenter, prospective, randomized, open-label trial Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE) did not demonstrate a clinical benefit of thrombus aspiration compared to percutaneous coronary intervention alone. We assessed the effect of type of aspiration device, stent type, direct stenting, and postdilatation on outcomes at 1 year. There was no difference in all-cause mortality, between the 3 most frequently used aspiration catheters (Eliminate [Terumo] 5.4%, Export [Medtronic] 5.0%, Pronto [Vascular Solutions] 4.5%) in patients randomized to thrombus aspiration. There was no difference in mortality between directly stented patients randomized to thrombus aspiration compared to patients randomized to percutaneous coronary intervention only (risk ratio 1.08, 95% CI 0.70 to 1.67, P=0.73). Similarly, there was no difference in mortality between the 2 randomized groups for patients receiving drug-eluting stents (risk ratio 0.89, 95% CI 0.63 to 1.26, P=0.50) or for those treated with postdilation (risk ratio 0.72, 95% CI 0.49 to 1.07, P=0.11). Furthermore, there was no difference in rehospitalization for myocardial infarction or stent thrombosis between the randomized arms in any of the subgroups.
Conclusions:
In patients with ST-elevation myocardial infarction randomized to thrombus aspiration, the type of aspiration catheter did not affect outcome. Stent type, direct stenting, or postdilation did not affect outcome irrespective of treatment with thrombus aspiration and percutaneous coronary intervention or percutaneous coronary intervention alone.
Clinical Trial Registration:
URL: ClinicalTrials.gov. Unique identifier: NCT01093404, https://clinicaltrials.gov/ct2/show/NCT01093404.
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