Manual Thrombectomy Does Not Improve Outcomes in High-Risk STEMI Patients


Manual thrombectomy in STEMI patients with a large area of myocardium at risk does not improve clinical outcomes at 1 year, leading researchers to conclude that there is no role for routine thrombus aspiration even in high-risk patients, according to a substudy of the TASTE trial presented in an oral abstract session on Tuesday. 

The main TASTE trial included 7,244 patients randomized to PCI alone or with thrombus aspiration. It found no difference at 30 days for the primary outcome of all-cause mortality.

The substudy was undertaken based on a hypothesis that the large number of low-risk patients in TASTE may have obscured the overall clinical benefit of thrombus aspiration in those having a large amount of myocardium at risk. The substudy used inclusion criteria from the INFUSE-AMI study, which found that aspiration was associated with less new-onset severe HF and rehospitalization for HF as well as a reduced rate of the composite of major adverse cardiac and HF events compared with no aspiration. 

Researchers selected 1,826 high-risk TASTE patients with infarct lesions in the proximal or mid-LAD, TIMI flow < 3 and a symptom onset to device time of less than 5 hours. Those patients were compared with 452 patients from INFUSE-AMI.

According to Fredrik Calais, MD, from Örebro University, Sweden, there was no difference at 1 year between upfront manual thrombectomy followed by PCI and PCI alone for the endpoints of all-cause mortality (HR 1.05; 95% CI 0.74-1.49), reinfarction (HR 0.87; 95% CI 0.51-1.46), HF (HR 1.1; 95% CI 0.77-1.58) or stent thrombosis (HR 0.75; 95% CI 0.3-1.86). Additionally, there was no difference in the combined rate of death, HF, MI or stent thrombosis at 1 year (Figure).

 Calais table

No benefit demonstrated

“Clinical outcomes in this high-risk subgroup are in line with main findings in the TASTE and TOTAL studies and with overall results in the INFUSE-AMI study,” said Fredrik Calais, MD, from Örebro University, Sweden.

“As opposed to the INFUSE-AMI study, this substudy did not demonstrate any benefit of thrombus aspiration on HF events in high-risk patients,” Calais said. ”This conclusion is based on 119 HF events as compared to 13 events in the INFUSE-AMI study.”

The researchers noted several baseline characteristics that differed between patients included in this substudy and those patients included in the INFUSE-AMI study. The main differences were that substudy patients had a higher mean age, were more likely to be in Killip class > 1 HF and to have TIMI flow < 2. Anticoagulation was specified in the INFUSE-AMI protocol and bivalirudin was given to nearly all patients in INFUSE-AMI compared with about 80% of patients in the substudy, while glycoprotein IIb/IIIa inhibitors were given to about half of all patients in INFUSE-AMI compared with 20% in the substudy.

Disclosures:

  • Calais reports no relevant conflicts of interest. 

 

 

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