No benefit to thrombus aspiration in STEMI

Thrombus aspiration in acute ST-segment elevation myocardial infarction (STEMI) is clinically appealing and often used prior to PCI. However, the majority of trials evaluating thrombus aspiration have failed to demonstrate significant mortality benefit. The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial is a multi-center study that randomized a total of 7244 presenting with a STEMI for primary PCI to either thrombus aspiration or PCI without prior aspiration. From this trial, the authors have previously reported no significant mortality difference at 30 days between routine thrombus aspiration and standard PCI. This publication is the 1-year follow-up data from the TASTE trial. At 1-year, there were no significant differences between aspiration and PCI alone for the outcomes of all-cause mortality (5.3% vs 5.6%; HR, 0.94; 95% CI, 0.78 to 1.15; P=0.57), recurrent myocardial infarction (2.7% vs. 2.7%, P=0.81) or stent thrombosis (0.7% vs. 0.9%, P=0.51). These results were consistent across all subgroups, including subgroups characterized by high TIMI thrombus burden where aspiration might be expected to have greater benefits.

Conclusions: In this large, well-conducted randomized controlled trial, mechanical thrombus aspiration demonstrated no benefit over standard PCI among patients presenting with STEMI. Although additional trials are ongoing, the weight of evidence increasingly suggests aspiration thrombectomy provides little to no benefit among patients with STEMI.

Summarized by Hussain Contractor and Steven M. Bradley

  • Lagerqvist B, Fröbert O, Olivecrona GK, Gudnason T, Maeng M, Alström P, Andersson J, Calais F, Carlsson J, Collste O, Götberg M, Hårdhammar P, Ioanes D, Kallryd A, Linder R, Lundin A, Odenstedt J, Omerovic E, Puskar V, Tödt T, Zelleroth E, Östlund O, James SK. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med. 2014 Sep 18;371(12):1111-20.