Thrombus aspiration before PCI in NSTEMI does not improve one-year outcomes

by Bruce Sylvester: Thrombus aspiration preceding percutaneous coronary intervention (PCI) failed to improve one-year clinical outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI), researchers from the TATORT-NSTEMI trial reported on Nov. 19, 2015 in the European Heart Journal: Acute Cardiovascular Care.

“TATORT-NSTEMI2 was the first randomized trial investigating the impact of thrombectomy prior to PCI, compared to standard PCI, in patients with NSTEMI. All previous trials had been performed in patients with ST-elevation myocardial infarction (STEMI),” said lead investigator Holger Thiele, M.D., professor of medicine and deputy director of the Heart Center at the University of Leipzig in Leipzig, Germany. “Patients needed to have a visible thrombus to be included in our study, which was not the case in the STEMI trials,” he added.
The investigators randomized 440 patients in a 1:1 ratio to thrombectomy before PCI or to standard PCI.
The primary endpoint was occurrence of major adverse cardiac events (MACE) at 12 months. MACE was defined as the composite of all-cause death, myocardial reinfarction, new congestive heart failure and need for target vessel revascularization.
The researchers reported no significant difference in MACE rates at 12 months between subjects receiving thrombus aspiration prior to PCI and those receiving standard PCI only.

MACE appeared in a total of 48 subjects (11.0%). In the pre-PCI thrombectomy cohort, MACE appeared in 19 subjects (8.7%) compared to 29 subjects (13.4%) in the standard PCI cohort, which was not a statistically significant difference (p=0.11).
“Aspiration thrombectomy appears to provide no additional benefit on long-term clinical outcome for patients with NSTEMI who have had PCI,” said Thiele. “This is comparable to data from the TASTE and TOTAL trials in STEMI patients which found no benefit of thrombectomy on all-cause mortality and led to the procedure being downgraded in European and American guidelines,” he added.

European Society of Cardiology (ESC) spokesperson Steen Kristensen, MD, professor of cardiology and director of the Cardiovascular Research Centre at Aarhus University in Aarhus, Denmark, said: “Large trials have shown that thrombus aspiration does not work in STEMI, so we no longer use it routinely, but we do use it occasionally. TATORT-NSTEMI confirms that this approach can also be applied in NSTEMI. We should think twice before we use a thrombus aspiration catheter but it might be useful in selected patients.”