Thrombus aspiration in STEMI fails to demonstrate benefit

Thrombus aspiration during primary PCI for patients presenting with ST elevation myocardial infarction (STEMI) is an intuitively attractive manoeuvre to aid rapid reperfusion, reduce distal embolization and improve microvascular perfusion.  Despite limited trial evidence of clinical benefit, the procedure has quickly taken hold in many PCI centres with European and US guidelines agreeing on a IIa recommendation for its use.

The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandanvia (TASTE) trial prospectively randomized a total of 7244 patients in an open-label fashion to thrombus aspiration or no thrombus aspiration with all patients receiving conventional treatment with PCI and stenting as indicated.  The trial utilized infrastructure from the pre-existing Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for efficient patient-enrollement and data collection.  At 30 days, thrombus aspiration did not improve mortality (2.8% vs 3.0%; hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.72 to 1.22; P=0.63), myocardial infarction (0.5% vs 0.9%; HR 0.61; 95% CI 0.34 to 1.07; P=0.09) or stent thrombosis (0.2% vs 0.5%; HR 0.47; 95% CI 0.20 to 1.02; P=0.06).

Conclusions

In this large prospective randomized trial, thrombus aspiration failed to demonstrate benefit in patients presenting acutely with STEMI. In a prior study, the clinical benefits of thrombus aspiration were not observed until longer term follow-up and suggest longer follow-up results from the current study may yet reveal benefit.  Further, this trial should be noted for the novel use of registry infrastructure allowing for a low-cost pragmatic clinical trial. This approach to trial design is likely to become more prevalent.

  • Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, Aasa M, Angerås O, Calais F, Danielewicz M, Erlinge D, Hellsten L, Jensen U, Johansson AC, Kåregren A, Nilsson J, Robertson L, Sandhall L, Sjögren I, Ostlund O, Harnek J and  James SK. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013 Oct 24;369(17):1587-97.