Baylor University Medical Center Proceedings July 2017 - 275

(P < 0.001). Morbidity and mortality
were not signiﬁcantly diﬀerent between
33
35
42
the two groups, as was also found in our
study. Other smaller trials like REMEDIA
(3) and DEAR-MI (4) also showed signiﬁcant beneﬁts of thrombus aspiration over
132
122
96%
routine PCI with regard to postprocedural
89
myocardial blush grade and ST-segment
resolution on the electrocardiogram.
In contrast, in the Trial of Routine
Conventional PCI
Thrombus aspiration
Conventional PCI
Thrombus aspiration
Aspiration Thrombectomy with PCI vera
b
sus PCI Alone in Patients with STEMI
TIMI flow 3
TIMI flow <3
ST resolution > 70
ST resolution < 70
(TOTAL), which involved 10,732 paFigure 4. Results for (a) the primary endpoint, TIMI flow grade, and (b) the secondary endpoint, ST resolution tients (5), the rate of incomplete ST segin the electrocardiogram.
ment resolution (<70%) was 27.0% in the
thrombectomy group versus 30.2% in the PCI alone group (P
signiﬁcant (P = 0.04). There were no statistically signiﬁcant
< 0.001). Rates of TIMI grade 3 ﬂow after PCI were the same
diﬀerences in major cardiac events between the two groups after
(93.1%) in the two groups (P = 0.12). Routine thrombectomy
a mean follow-up period of 4 days (Table 1).
was associated with an increased rate of stroke within 30 days.
In contrast, no patient in either group developed stoke in our
DISCUSSION
study. The ﬁndings of the TOTAL trial with regard to the eﬃcacy
We compared the outcome of thrombus aspiration and stenting
of thrombectomy are consistent with those of the Thrombus
with conventional PCI without thrombus aspiration. The primary
Aspiration in ST-Elevation Myocardial Infarction in Scandinavia
endpoint, TIMI ﬂow grade, was found to be higher in patients who
(TASTE) trial (6) and the Intracoronary Abciximab and Aspirahad undergone thrombus aspiration: 132 patients in the thromtion Thrombectomy in Patients with Large Anterior Myocardial
bus aspiration group had a TIMI grade 3 ﬂow compared with 96
Infarction (INFUSE-AMI) trial (7).
patients in the conventional PCI group (P = 0.01). ST-segment
resolution was also signiﬁcantly higher in the thrombus aspiration
1. Venkitachalam L, Kip KE, Selzer F, Wilensky RL, Slater J, Mulukutla
group than in the conventional PCI group (P = 0.04). For other
SR, Marroquin OC, Block PC, Williams DO, Kelsey SF. Twenty-year
secondary endpoints such as recurrent angina, reinfarction, heart
evolution of percutaneous coronary intervention and its impact on clinical
failure, major bleeding, disabling stroke, or mortality, there were no
outcomes. Circ Cardiovasc Interv 2009;2(1):6-13.
statistically signiﬁcant diﬀerences between the two groups.
2. Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den
Our study results corroborate the results of the Thrombus
Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F.
Thrombus aspiration during primary percutaneous coronary intervention.
Aspiration during Percutaneous Coronary Intervention in Acute
N Engl J Med 2008;358(6):557-567.
Myocardial Infarction Study (TAPAS), which enrolled 1071
3. Burzotta F, Trani C, Romagnoli E, Mazzari MA, Rebuzzi AG, De Vita M,
patients (2). That study showed signiﬁcant improvement in the
Garramone B, Giannico F, Niccoli G, Biondi-Zoccai GG, Schiavoni G,
TIMI blush grade in patients receiving thrombus aspiration. A
Mongiardo R, Crea F. Manual thrombus-aspiration improves myocardial
myocardial blush grade of 0 or 1 occurred in 17.1% of the pareperfusion: the randomized evaluation of the eﬀect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue
tients in the thrombus aspiration group and in 26.3% of those in
angioplasty (REMEDIA) trial. J Am Coll Cardiol 2005;46(2):371-376.
the conventional PCI group (P < 0.001). The TAPAS trial also
4. Silva-Orrego P, Colombo P, Bigi R, Gregori D, Delgado A, Salvade P, Oreglia
showed a signiﬁcant diﬀerence in the ST-segment deviation in the
J, Orrico P, de Biase A, Piccalò G, Bossi I, Klugmann S. Thrombus aspiration
thrombus aspiration group: complete resolution of ST-segment
before primary angioplasty improves myocardial reperfusion in acute myocarelevation occurred in 56.6% and 44.2% of patients in the thromdial infarction: the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion
in Myocardial Infarction) study. J Am Coll Cardiol 2006;48(8):1552-1559.
bus aspiration group and conventional PCI group, respectively
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

23

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

5.

Table 1. Major cardiac events in the thrombus aspiration group
and conventional PCI group
Event
Reinfarction

Thrombus aspiration
group (n = 155)

Conventional PCI
group (n = 131)

P

5 (3.3%)

8 (6.1%)

0.24

Major bleeding

3 (1.9%)

5 (3.8%)

0.34

Recurrent angina pectoris

11 (7.7%)

14 (11.5%)

0.28

Heart failure

10 (6.5%)

13 (9.9%)

0.29

Death

7 (4.5%)

8 (6.2%)

0.55

July 2017

6.

7.

Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al.; TOTAL
Investigators. Randomized trial of primary PCI with or without routine
manual thrombectomy. N Engl J Med 2015;372(15):1389-1398.
Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T,
Maeng M, Aasa M, Angerås O, Calais F, Danielewicz M, Erlinge D,
Hellsten L, Jensen U, Johansson AC, Kåregren A, Nilsson J, Robertson
L, Sandhall L, Sjögren I, Ostlund O, Harnek J, James SK; TASTE Trial.
Thrombus aspiration during ST-segment elevation myocardial infarction.
N Engl J Med 2013;369(17):1587-1597.
Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink
JH, Ochala A, Carlton TW, Cristea E, Wolﬀ SD, Brener SJ, Chowdhary S,
El-Omar M, Neunteuﬂ T, Metzger DC, Karwoski T, Dizon JM, Mehran
R, Gibson CM. Intracoronary abciximab and aspiration thrombectomy
in patients with large anterior myocardial infarction: the INFUSE-AMI
randomized trial. JAMA 2012;307(17):1817-1826.

Effect of thrombus aspiration on angiography and outcome

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