Long-term outcome after thrombus aspiration in non-ST-elevation myocardial infarction: results from the TATORT-NSTEMI tr
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ORIGINAL PAPER
Long‑term outcome after thrombus aspiration in non‑ST‑elevation myocardial infarction: results from the TATORT‑NSTEMI trial Thrombus aspiration in acute myocardial infarction Hans‑Josef Feistritzer1 · Roza Meyer‑Saraei2 · Christiane Lober3 · Michael Böhm4 · Bruno Scheller4 · Bernward Lauer5 · Tobias Geisler6 · Meinrad Gawaz6 · Leonhard Bruch7 · Norbert Klein8 · Uwe Zeymer3,9 · Ingo Eitel2 · Alexander Jobs1 · Anne Freund1 · Steffen Desch1 · Suzanne de Waha‑Thiele2 · Holger Thiele1 Received: 24 November 2019 / Accepted: 29 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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-STelevation 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. Keywords Non-ST-elevation myocardial infarction · Percutaneous coronary intervention · Thrombectomy · Clinical outcome
Introduction Aspiration thrombectomy during primary percutaneous coronary intervention (PCI) had been routinely used for treatment of ST-elevation myocardial infarction (STEMI) for many years, aiming to reduce distal embolization of Hans-Josef Feistritzer and Roza Meyer-Saraei should be considered as first authors. Suzanne de Waha-Thiele and Holger Thiele should be considered as senior authors. * Holger Thiele [email protected]‑leipzig.de Extended author information available on the last page of the article
thrombotic material and improve myocardial reperfusion [1]. However, two large randomized controlled trials powered for hard clinical endpoints showed no benefit on clinical outcomes of the routine thrombus aspiration strategy over conventional PCI [2, 3]. These data resulted in downgrading to a class III re
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