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 Thiele10. 1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany. 2. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany. 3. Institut für Herzinfarktforschung GmbH, IHF, Ludwigshafen, Germany. 4. Department of Internal Medicine III, University of Saarland, Homburg, Germany. 5. Department of Cardiology, University Hospital Jena, Jena, Germany. 6. Department of Cardiology/Cardiovascular Medicine, University of Tübingen, Tübingen, Germany. 7. Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin, Germany. 8. Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum St. Georg, Leipzig, Germany. 9. Klinik für Innere Medizin/Kardiologie, Klinikum Ludwigshafen, Ludwigshafen, Germany. 10. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany. Holger.Thiele@medizin.uni-leipzig.de.
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.
RCT Entities:
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.