Long-term outcome after thrombus aspiration in non-ST-elevation myocardial infarction: results from the TATORT-NSTEMI trial : Thrombus aspiration in acute myocardial infarction.

Abstract

AIMS:

To investigate the long-term prognostic value of aspiration thrombectomy in conjunction with primary percutaneous coronary intervention (PCI) compared to conventional PCI in patients with non-ST-elevation myocardial infarction (NSTEMI).

METHODS:

In the randomized TATORT-NSTEMI (Thrombus aspiration in thrombus containing culprit lesions in non-ST-elevation myocardial infarction) trial, NSTEMI patients with thrombus containing culprit lesions were randomized to either PCI with aspiration thrombectomy or conventional PCI. The endpoint was a combination of all-cause death, reinfarction and new congestive heart failure.

RESULTS:

From 440 patients initially randomized, outcome data were available in 432 (98.2%) patients at a median follow-up of 4.9 (interquartile range [IQR] 4.4-5.0) years. Thrombectomy was associated with a significant reduction of the combined endpoint compared to conventional PCI (19.9% vs. 30.7%, p = 0.01). This finding was primarily driven by a reduced rate of reinfarction with thrombectomy (3.4% vs. 10.3%, p = 0.01). Thrombectomy was still independently associated with the combined endpoint after multivariable adjustment (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.30-0.76, p = 0.002). Findings were consistent across all analyzed subgroups (p values for interaction all > 0.05).

CONCLUSIONS:

In NSTEMI, thrombus aspiration is associated with favorable clinical outcome during long-term follow-up.

CLINICAL TRIAL REGISTRATION:

NCT01612312.

• Authors: Hans-Josef Feistritzer, Roza Meyer-Saraei, Christiane Lober, Michael Böhm, Bruno Scheller, Bernward Lauer, Tobias Geisler, Meinrad Gawaz, Leonhard Bruch, Norbert Klein, Uwe Zeymer, Ingo Eitel, Alexander Jobs, Anne Freund, Steffen Desch, Suzanne de Waha-Thiele, Holger Thiele
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 109 Issue 10 Pg. 1223-1231 (Oct 2020) ISSN: 1861-0692 [Electronic] Germany
• PMID: 32030497 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Aged
• Coronary Thrombosis (therapy)
• Female
• Follow-Up Studies
• Heart Failure (epidemiology, etiology)
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (therapy)
• Percutaneous Coronary Intervention (methods)
• Thrombectomy (methods)
• Treatment Outcome