TATORT-NSTEMI: Thrombus aspiration fails to improve outcomes at 1 year

Routine thrombus aspiration before PCI did not result in significantly improved health outcomes in patients with non-STEMI during the first year after the procedure, according to results of the TATORT-NSTEMI trial published in the European Heart Journal: Acute Cardiovascular Care.

In the first randomized trial investigating the utility of routine thrombectomy before PCI in patients with non-STEMI, compared with patients who underwent standard PCI, researchers found that after 1 year, the incidence of MACE, including death, myocardial reinfarction, target vessel revascularization and congestive HF, were similar in both groups.

“Aspiration thrombectomy appears to provide no additional benefit on long-term clinical outcome for patients with non-STEMI who have had PCI,” Holger Thiele, MD, director of the Medical Clinic II at the University Hospital Schleswig-Holstein in Lübeck, Germany, said in a press release. “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.”

The researchers designed the trial to test the hypothesis that thrombus aspiration paired with PCI, when compared with PCI alone, results in a reduction in microvascular blockage, as observed by cardiac MRI.

The prospective, controlled, multicenter, randomized, open-label TATORT-NSTEMI trial assigned 440 patients (median age, 69 years) with non-STEMI and thrombus-containing lesions to aspiration thrombectomy or standard PCI only. In total, the thrombus aspiration group included 221 patients (158 men) and the standard PCI group included 219 patients (163 men).

The primary endpoint was MACE at 12-month follow-up. Assessments of functional outcomes by NYHA class and Canadian Cardiovascular Society (CCS) class, as well as a quality of life, using the EuroQol-5D (EQ-5D) questionnaire, represented secondary endpoints.

After 1 year, MACE occurred in 19 patients in the thrombectomy group vs. 29 in the standard PCI group. In terms of functional outcomes, most patients did not display symptoms of dyspnea and angina. In addition, researchers observed no significant differences reported in the NYHA (P = .7) and CCS (P = .68) classes, nor in the EQ-5D questionnaire.

“This was a negative trial, so it is unlikely to result in a change in the guidelines, but in practice it means that clinicians will follow the STEMI recommendations,” Thiele said. “In other words, thrombus aspiration will not be used routinely in patients with non-STEMI but could be applied in bail out situations when patients have a lot of thrombus and no reflow after PCI. This is a reasonable solution.” – by Jason Laday

Source: www.healio.com