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Long-term outcome after thrombus aspiration in non-ST-elevation myocardial infarction: results from the TATORT-NSTEMI trial

Thrombus aspiration in acute myocardial infarction

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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.

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Funding

Supported by Terumo Europe, Leuven, Belgium and Alliance of Daiichi Sankyo Germany GmbH, Munich and Lilly Germany GmbH, Bad Homburg.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany

    Hans-Josef Feistritzer, Alexander Jobs, Anne Freund, Steffen Desch & Holger Thiele

  2. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany

    Roza Meyer-Saraei, Ingo Eitel & Suzanne de Waha-Thiele

  3. Institut für Herzinfarktforschung GmbH, IHF, Ludwigshafen, Germany

    Christiane Lober & Uwe Zeymer

  4. Department of Internal Medicine III, University of Saarland, Homburg, Germany

    Michael Böhm & Bruno Scheller

  5. Department of Cardiology, University Hospital Jena, Jena, Germany

    Bernward Lauer

  6. Department of Cardiology/Cardiovascular Medicine, University of Tübingen, Tübingen, Germany

    Tobias Geisler & Meinrad Gawaz

  7. Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin, Germany

    Leonhard Bruch

  8. Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum St. Georg, Leipzig, Germany

    Norbert Klein

  9. Klinik für Innere Medizin/Kardiologie, Klinikum Ludwigshafen, Ludwigshafen, Germany

    Uwe Zeymer

Authors
  1. Hans-Josef Feistritzer
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  2. Roza Meyer-Saraei
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  3. Christiane Lober
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  4. Michael Böhm
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  5. Bruno Scheller
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  6. Bernward Lauer
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  7. Tobias Geisler
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  8. Meinrad Gawaz
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  9. Leonhard Bruch
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  10. Norbert Klein
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  11. Uwe Zeymer
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  12. Ingo Eitel
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  13. Alexander Jobs
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  14. Anne Freund
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  15. Steffen Desch
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  16. Suzanne de Waha-Thiele
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  17. Holger Thiele
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Corresponding author

Correspondence to Holger Thiele.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The present study was performed in accordance with the 1964 Declaration of Helsinki. The study including the current long-term follow-up was approved by the lead and all local ethical committees and all patients provided written informed consent before study inclusion.

Additional information

Hans-Josef Feistritzer and Roza Meyer-Saraei should be considered as first authors. Suzanne de Waha-Thiele and Holger Thiele should be considered as senior authors.

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Feistritzer, HJ., Meyer-Saraei, R., Lober, C. et al. Long-term outcome after thrombus aspiration in non-ST-elevation myocardial infarction: results from the TATORT-NSTEMI trial. Clin Res Cardiol 109, 1223–1231 (2020). https://doi.org/10.1007/s00392-020-01613-0

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  • DOI: https://doi.org/10.1007/s00392-020-01613-0

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