TASTE trial challenge current practice of blood clot aspiration after heart attack

September 1, 2013, European Society of Cardiology

Aspiration of the blood clot or "thrombus" that causes a heart attack before re-opening a patient's artery with a balloon catheter does not improve survival compared to performing balloon dilation and stenting alone according to the results of the Thrombus Aspiration in ST- Elevation myocardial infarction in Scandinavia (TASTE) trial.

"We believe that TASTE questions the usefulness of thrombus as a routine adjunct and the recommendation for its general use in international guidelines should probably be down-graded," said lead author Ole Fröbert, MD, PhD, from the Department of Cardiology at Örebro University Hospital, in Örebro, Sweden.

The multicenter, prospective, randomized, controlled open-label trial enrolled 7244 with STEMI from Sweden, Denmark and Iceland who had a diagnosis of ST-elevation (STEMI).

Half of the patients were assigned to balloon treatment only (known as percutaneous , or PCI) and the other half had their blood clot aspirated before PCI.

The mortality rate at 30 days post-surgery procedure was not statistically different between the groups (3.0% versus 2.8% respectively).

Similarly, there was no difference between the two groups for secondary endpoints including risk of attack, stroke and complications related to the treatment.

Even high risk groups such as smokers, patients with diabetes or patients with large clots had similar results with either approach.

"Our findings do not support a role for this additional procedure as a routine future treatment," said Dr. Fröbert.

The study results will likely have an immediate impact on clinical practice, he added.

Current European Society of Cardiology guidelines on treatment of patients with ST-elevation myocardial infarction (STEMI) recommend that thrombus aspiration should be considered and "most opinion leaders advocate its use," said study co-chair Stefan James MD, PhD, from the Department of Cardiology and Uppsala Clinical Research Center at Uppsala University Hospital in Uppsala, Sweden.

Since the presentation of the TAPAS trial that suggested a mortality benefit (N Engl J Med 2008;358:557-67) thrombus aspiration has "gained an enormous popularity," he explained. "The therapy is so popular among interventional cardiologists because it intuitively feels beneficial to aspirate the clot that closes the artery."

But recent research has suggested that thrombus aspiration also carries risks. In 2012, a meta-analysis associated the procedure with a borderline significantly higher rate of stroke (Int J Cardiol 2012;166:606-12.) and another study showed that systemic embolization can occur as result (Circ J 2009;73:1356-8).

The TASTE trial is the first large-scale randomized trial of thrombus aspiration for STEMI to be large enough to reveal meaningful findings on mortality and morbidity.

It enrolled more patients than all previous randomized trials of this procedure combined and included a much broader range of patients in order to make the results relevant to everyday clinical practice.

"An even more far-reaching impact is that our trial is the first trial ever to use the registry based trial concept, which we invented, " added Dr. Fröbert.

The study's unique Registry-Based Randomized Clinical Trial (RRCT) protocol used national registries as on-line platforms for randomization, case record forms and follow-up, making the trial economically and administratively feasible.

"This concept reduces costs to 1% or less of a conventional randomized trial and enables the testing of treatments that have no revenue potential. since commercial interest is often the main incentive behind large-scale randomized clinical trials," he said. "In general fewer of these trials are being performed because of the huge costs involved. This trial concept can help to break the deadlock of clinical ."

Explore further: Infusion of drug into the coronary artery may help reduce size of heart damage after heart attack

Related Stories

Infusion of drug into the coronary artery may help reduce size of heart damage after heart attack

March 25, 2012
Administration of a bolus dose of the anticoagulant drug abciximab into the coronary artery involved in causing a certain type of heart attack among patients who were undergoing a percutaneous coronary intervention and also ...

Long-term outcome similar with thrombus aspiration and stents in PCI

May 2, 2012
New research confirms thrombus aspiration (TA) during percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) provides long-term outcomes similar to conventional ...

Clot-busting drug as effective as angioplasty

March 12, 2013
A clot-busting therapy may benefit some heart attack patients who cannot have immediate angioplasty, according to research presented today at the American College of Cardiology's 62nd Annual Scientific Session.

Trial finds benefits to using radial versus femoral access for primary angioplasty in heart attack patients

October 26, 2012
OCTOBER 26, 2012 – A study found several benefits in using the radial artery in the arm as the entry point for angioplasty or percutaneous coronary intervention (PCI) compared to the femoral artery in the leg. Results of ...

Anticoagulant does not reduce rate of ischemic events among certain patients undergoing PCI

September 1, 2013
Use of the novel anticoagulant otamixaban did not reduce ischemic events compared with unfractionated heparin plus eptifibatide but increased bleeding among patients with non–ST-segment elevation acute coronary syndromes ...

Results of the RIFLE STEACS clinical trial reported at TCT 2011

November 10, 2011
Results of a randomized clinical trial suggest that using the transradial approach for angioplasty in patients with ST elevation acute coronary syndrome is preferable to the femoral approach, and should be the recommended ...

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.