News Release

Thrombus aspiration after heart attack results in better 1-year outcome than conventional treatment

Peer-Reviewed Publication

The Lancet_DELETED

Treating acute heart attack with thrombus aspiration (TA) results in improved 1-year clinical outcomes compared with the conventional treatment of percutaneous coronary intervention (PCI) alone. These are the conclusions of authors of an Article published in this week's edition of The Lancet.

An acute heart attack is caused by rupture of an atherosclerotic plaque within the artery, initiating a blood clot (thrombus), which leads to total or partial blockage of the artery. During the acute phase of a heart attack, the primary aim is to restore blood-flow through this blocked artery. Currently, PCI is the preferred treatment for acute heart attack and includes balloon predilatation of the blocked artery followed by implantation of a coronary stent. However, PCI can be complicated by embolisation* of thrombotic material from the ruptured plaque causing further obstructions in the downstream blood microvessels. Such microvascular complication results in reduced blood flow to the affected area of the heart muscle.

A thrombus can, however, be removed using a thrombus aspiration catheter**, and, after this, balloon predilatation is often unnecessary and the stent can be directly implanted. Prof Felix Zijlstra and Dr Pieter-Jan Vlaar, University Medical Centre Groningen, Netherlands, and colleagues did a 1-year follow-up study of the TAPAS*** trial, in which patients were randomly assigned in a 1:1 ratio to either thrombus aspiration (535 patients) or conventional treatment (balloon dilatation followed by stent implantation, 536 patients).

The researchers found that cardiac death at one year was 3.6% in the thrombus aspiration group, and 6.7% in the conventional treatment group. The combined end-point of cardiac death or non-fatal heart attack occurred in 5.6% of patients in the thrombus aspiration group and 9.9% of patients in the conventional treatment group. They say: "In conclusion, 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."

They add: "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."****

In an accompanying Comment, Dr Francesco Burzotta and Professor Filippo Crea, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy, say: "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."

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Notes to editors:

*embolisation: dislodging of thrombotic material from the ruptured plaque in the downstream blood microvessels

**thombus aspiration catheter: an aspiration catheter is a flexible tube with non-traumatic tip, which is advanced into the blocked artery. The thrombus causing the blockage is sucked-out through the catheter into a lockable syringe, which is located outside the body.

***TAPAS: Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study

****quote direct from author, cannot be found in Article

Press Office, University Medical Centre Groningen, Netherlands, T) +31 (0) 503 612200 E) f.zijlstra@thorax.umcg.nl / p.j.j.vlaar@thorax.umcg.nl

Dr Francesco Burzotta, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy T) +39 349 4295290 E) f.burzotta@rm.unicatt.it

http://multimedia.thelancet.com/pdf/press/thrombusaspiration.pdf


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