Benefits Seen In Thrombus Aspiration After Acute Heart Attack

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Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics;  Blood / Hematology
Article Date: 06 Jun 2008 - 0:00 PDT

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A study published in this week's edition of The Lancet reports that 1-year clinical outcomes were improved for acute heart attack patients who were treated with thrombus aspiration (TA) rather than the conventional treatment of percutaneous coronary intervention (PCI).

When there is total or partial blockage of an artery due to a thrombus (blood clot) caused by the rupturing of atherosclerotic plaque, the patient is considered to be suffering an acute heart attack. At this point, the main concern is to restore blood flow through the blocked artery. The traditional treatment for acute heart attack is called percutaneous coronary intervention (PCI) and requires a balloon predilatation of the blocked artery and the insertion of a coronary stent. PCI, however, can potentially dislodge thrombotic material from the ruptured plaque that is sent downstream and obstructs blood microvessels (embolization). Ultimately, this microvascular complication leads to significantly reduced blood flow to heart muscle. A second possible treatment for thrombus removal requires use of a thrombus aspiration catheter - a flexible tube that is inserted into the affected artery to suck out the blockage. Often, the TA procedure makes balloon predilatation unnecessary, allowing direct implantation of the stent.

To investigate the differences in outcomes of these the PCI and TA procedures, Prof Felix Zijlstra and Dr Pieter-Jan Vlaar (University Medical Centre Groningen, Netherlands) and colleagues conducted a 1-year follow-up study of the Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS) trial. The trial consisted of 535 patients who were randomly assigned to thrombus aspiration and 536 patients randomly assigned to conventional PCI treatment (balloon dilatation followed by stent implantation).

The analysis revealed that cardiac death at one year was 3.6% in the TA group and 6.7% in the PCI group. The researchers also found a lower incidence of cardiac death or non-fatal heart attack in the TA group than in the PCI group - 5.6% vs. 9.9%.

"Compared with conventional PCI, thrombus aspiration before stenting of the infarct-related artery results in improved myocardial perfusion and seems to improve clinical outcome 1 year after PCI for acute heart attack," conclude the authors. "We are the first to demonstrate the efficacy of thrombus aspiration in terms of improved clinical outcome. Based on these results, thrombus aspiration will be increasingly utilised in routine clinical practice in the Netherlands and elsewhere in the world."

An accompanying comment, written by Dr Francesco Burzotta and Professor Filippo Crea (Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy), notes that, "The search for further treatments aimed at targeting the different pathogenic components should continue if we are eventually to overcome incomplete perfusion. In the meantime the notion that, during primary PCI, aspiration is better than predilatation will probably soon influence clinical guidelines. This development will be favoured by the low cost and easy use of thrombus-aspirating catheters, which make them ready for use in all catheterisation laboratories that treat patients with acute myocardial infarction."

Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study
P J Vlaar et al.
The Lancet (2008). 371[9628]: pp. 1915 - 1920.
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Written by: Peter M Crosta
Copyright: Medical News Today
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