Thrombus aspiration in patients with ST elevation myocardial infarction improves mortality at 1 year in the TAPAS trial

March 30, 2008 By Vijayalakshmi Kunadian MBBS MD MRCP [mailto:vkunadian@perfuse.org]

SCAI-ACCi2 08-Chicago, IL: Researchers from the Netherlands reported today that thrombus aspiration during coronary angioplasty for acute myocardial infarction improves one year mortality compared with conventional percutaneous coronary intervention (PCI). Dr Felix Zijlstra presented the results at the SCAI-i2 summit Annual Scientific Sessions in Chicago today.

Distal embolization during PCI results in adverse clinical outcomes. Several devices have been developed to reduce the risk of distal embolization of plaque and thrombus during PCI. These devices fall into 3 broad categories:
 * Thrombus extraction devices
 * Proximal protection devices
 * Distal protection devices

The distal protection devices have been associated with reductions in major adverse cardiac events (MACE) during vein graft interventions but not during native vessel PCI. It has been hypothesized that this could be because the devices themselves may be associated with distal or proximal embolization and may be associated with damage to the previously uninvolved segments of the myocardium.

In a recent issue of the New England Journal of Medicine, Svilaas and colleagues from the Netherlands undertook a study using the Export catheter during primary PCI called the TAPAS study (Thrombus Aspiration in Percutaneous coronary intervention following Acute myocardial infarction Study) and the initial results were previously reported (source 2). This study demonstrated that the use of thrombus aspiration was associated with an improvement in myocardial blush grades (MBG) and ST segment resolution. Improved myocardial perfusion was associated with favorable clinical outcomes.

In today's presentation, the investigators present the one year clinical follow-up results from this study. Thrombus aspiration before primary PCI was associated with reduced mortality at one year compared to conventional PCI group (p=0.040). The combined mortality and non-fatal reinfarction rates also were reduced among the thrombus aspiration group (p=0.016). The death or reinfarction rates were significantly higher among patients with impaired myocardial perfusion (grades 0/1) compared to those with MBG 2 and MBG 3 (14.8% vs. 7.6% vs. 6.1%, p=0.001 respectively).

Among patients with ST elevation MI, the TAPAS study demonstrates that thrombus aspiration improves myocardial perfusion and lowers mortality at 1 year. Improved myocardial perfusion at the completion of the procedure is associated with lower mortality at 1 year.

Source

 * 1) Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 30, 2008 Chicago
 * 2) http://wikidoc.org/index.php/Clot_retrieval_from_the_coronary_arteries_during_primary_angioplasty_improves_myocardial_perfusion_and_clinical_outcomes