FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 358:557-567 February 7, 2008 Number 6 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Vetrovec, G. W. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Primary percutaneous coronary intervention (PCI) is effective in opening the infarct-related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion.

Methods We performed a randomized trial assessing whether manual aspiration was superior to conventional treatment during primary PCI. A total of 1071 patients were randomly assigned to the thrombus-aspiration group or the conventional-PCI group before undergoing coronary angiography. Aspiration was considered to be successful if there was histopathological evidence of atherothrombotic material. We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcome. The primary end point was a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively).

Results A myocardial blush grade of 0 or 1 occurred in 17.1% of the patients in the thrombus-aspiration group and in 26.3% of those in the conventional-PCI group (P<0.001). Complete resolution of ST-segment elevation occurred in 56.6% and 44.2% of patients, respectively (P<0.001). The benefit did not show heterogeneity among the baseline levels of the prespecified covariates. At 30 days, the rate of death in patients with a myocardial blush grade of 0 or 1, 2, and 3 was 5.2%, 2.9%, and 1.0%, respectively (P=0.003), and the rate of adverse events was 14.1%, 8.8%, and 4.2%, respectively (P<0.001). Histopathological examination confirmed successful aspiration in 72.9% of patients.

Conclusions Thrombus aspiration is applicable in a large majority of patients with myocardial infarction with ST-segment elevation, and it results in better reperfusion and clinical outcomes than conventional PCI, irrespective of clinical and angiographic characteristics at baseline. (Current Controlled Trials number, ISRCTN16716833 [controlled-trials.com] .)

Source Information

From the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Address reprint requests to Dr. Svilaas at the Thorax Center, Department of Cardiology, Triadegebouw, Gang LM1.004, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands, or at fzijlstra{at}thorax.umcg.nl.

Full Text of this Article

Related Letters:

Thrombus Aspiration during Primary Percutaneous Coronary Intervention
Uretsky B. F., Mongeon F.-P., Eisenberg M. J., Rinfret S., Tomoda H., Izumi N., Aoki N., Amato J. L. Jr., Shamoon F. E., Haft J. I., Svilaas T., Zijlstra F., the TAPAS Investigators
Extract | Full Text | PDF  
N Engl J Med 2008; 358:2639-2641, Jun 12, 2008. Correspondence

This article has been cited by other articles:

• Heusch, G., Kleinbongard, P., Bose, D., Levkau, B., Haude, M., Schulz, R., Erbel, R. (2009). Coronary Microembolization: From Bedside to Bench and Back to Bedside. Circulation 120: 1822-1836 [Abstract] [Full Text]  
• Haeck, J. D.E., Koch, K. T., Bilodeau, L., Van der Schaaf, R. J., Henriques, J. P.S., Vis, M. M., Baan, J. Jr, Van der Wal, A. C., Piek, J. J., Tijssen, J. G.P., Krucoff, M. W., De Winter, R. J. (2009). Randomized Comparison of Primary Percutaneous Coronary Intervention With Combined Proximal Embolic Protection and Thrombus Aspiration Versus Primary Percutaneous Coronary Intervention Alone in ST-Segment Elevation Myocardial Infarction: The PREPARE (PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation) Study. J Am Coll Cardiol Intv 2: 934-943 [Abstract] [Full Text]  
• Liistro, F., Grotti, S., Angioli, P., Falsini, G., Ducci, K., Baldassarre, S., Sabini, A., Brandini, R., Capati, E., Bolognese, L. (2009). Impact of Thrombus Aspiration on Myocardial Tissue Reperfusion and Left Ventricular Functional Recovery and Remodeling After Primary Angioplasty. Circ Cardiovasc Intervent 2: 376-383 [Abstract] [Full Text]  
• Hetherington, S L, Adam, Z, Morley, R, de Belder, M A, Hall, J A, Muir, D F, Sutton, A G C, Swanson, N, Wright, R A (2009). Primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: changing patterns of vascular access, radial versus femoral artery. Heart 95: 1612-1618 [Abstract] [Full Text]  
• Sezer, M., Cimen, A., Aslanger, E., Elitok, A., Umman, B., Bugra, Z., Yormaz, E., Turkmen, C., Adalet, I.s., Nisanci, Y., Umman, S. (2009). Effect of intracoronary streptokinase administered immediately after primary percutaneous coronary intervention on long-term left ventricular infarct size, volumes, and function.. J Am Coll Cardiol 54: 1065-1071 [Abstract] [Full Text]  
• Burzotta, F., De Vita, M., Gu, Y. L., Isshiki, T., Lefevre, T., Kaltoft, A., Dudek, D., Sardella, G., Orrego, P. S., Antoniucci, D., De Luca, L., Biondi-Zoccai, G. G.L., Crea, F., Zijlstra, F. (2009). Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur Heart J 0: ehp348v1-ehp348 [Abstract] [Full Text]  
• Fokkema, M. L., Vlaar, P. J., Vogelzang, M., Gu, Y. L., Kampinga, M. A., de Smet, B. J., Jessurun, G. A., Anthonio, R. L., van den Heuvel, A. F., Tan, E.-S., Zijlstra, F. (2009). Effect of High-Dose Intracoronary Adenosine Administration During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: A Randomized Controlled Trial. Circ Cardiovasc Intervent 2: 323-329 [Abstract] [Full Text]  
• Niccoli, G., Burzotta, F., Galiuto, L., Crea, F. (2009). Myocardial no-reflow in humans.. J Am Coll Cardiol 54: 281-292 [Abstract] [Full Text]  
• Dixon, S. R., Grines, C. L., O'Neill, W. W. (2009). The year in interventional cardiology.. J Am Coll Cardiol 53: 2080-2097 [Full Text]  
• Lee, C.-H., Khoo, S.-M., Tai, B.-C., Chong, E. Y., Lau, C., Than, Y., Shi, D.-X., Lee, L.-C., Kailasam, A., Low, A. F., Teo, S.-G., Tan, H.-C. (2009). Obstructive Sleep Apnea in Patients Admitted for Acute Myocardial Infarction: Prevalence, Predictors, and Effect on Microvascular Perfusion. Chest 135: 1488-1495 [Abstract] [Full Text]  
• Guagliumi, G. (2009). Emerging data and decision for optimizing STEMI management: the European perspective. Eur Heart J Suppl 11: C19-C24 [Abstract] [Full Text]  
• Mehta, R. H., Starr, A. Z., Lopes, R. D., Hochman, J. S., Widimsky, P., Pieper, K. S., Armstrong, P. W., Granger, C. B., for the APEX AMI Investigators, (2009). Incidence of and Outcomes Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention. JAMA 301: 1779-1789 [Abstract] [Full Text]  
• Fokkema, M. L., Vlaar, P. J., Svilaas, T., Vogelzang, M., Amo, D., Diercks, G. F.H., Suurmeijer, A. J.H., Zijlstra, F. (2009). Incidence and clinical consequences of distal embolization on the coronary angiogram after percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J 30: 908-915 [Abstract] [Full Text]  
• Srinivasan, M., Rihal, C., Holmes, D. R., Prasad, A. (2009). Adjunctive Thrombectomy and Distal Protection in Primary Percutaneous Coronary Intervention: Impact on Microvascular Perfusion and Outcomes. Circulation 119: 1311-1319 [Abstract] [Full Text]  
• Vogelzang, M., Vlaar, P. J., Svilaas, T., Amo, D., Nijsten, M. W.N., Zijlstra, F. (2009). Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: a substudy from the TAPAS trial. Eur Heart J 30: 594-599 [Abstract] [Full Text]  
• Carlsson, M., Wilson, M., Martin, A. J., Saeed, M. (2009). Myocardial Microinfarction after Coronary Microembolization in Swine: MR Imaging Characterization. Radiology 250: 703-713 [Abstract] [Full Text]  
• Sardella, G., Mancone, M., Bucciarelli-Ducci, C., Agati, L., Scardala, R., Carbone, I., Francone, M., Di Roma, A., Benedetti, G., Conti, G., Fedele, F. (2009). Thrombus Aspiration During Primary Percutaneous Coronary Intervention Improves Myocardial Reperfusion and Reduces Infarct Size The EXPIRA (Thrombectomy With Export Catheter in Infarct-Related Artery During Primary Percutaneous Coronary Intervention) Prospective, Randomized Trial.. J Am Coll Cardiol 53: 309-315 [Abstract] [Full Text]  
• Hamm, C. W., Möllmann, H., Bassand, J.-P., van de Werf, F. (2009). CHAPTER 16 Acute Coronary Syndromes. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full Text]  
• De Luca, G., Dudek, D., Sardella, G., Marino, P., Chevalier, B., Zijlstra, F. (2008). Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J 29: 3002-3010 [Abstract] [Full Text]  
• Bavry, A. A., Kumbhani, D. J., Bhatt, D. L. (2008). Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur Heart J 29: 2989-3001 [Abstract] [Full Text]  
• Steg, P. G., Ducrocq, G. (2008). Devices to protect against embolization during primary angioplasty for ST-segment elevation myocardial infarction: the good, the bad and the ugly. Eur Heart J 29: 2953-2954 [Full Text]  
• Authors/Task Force Members, , Van de Werf, F., Bax, J., Betriu, A., Blomstrom-Lundqvist, C., Crea, F., Falk, V., Filippatos, G., Fox, K., Huber, K., Kastrati, A., Rosengren, A., Steg, P. G., Tubaro, M., Verheugt, F., Weidinger, F., Weis, M., ESC Committee for Practice Guidelines (CPG), , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., Document Reviewers, , Silber, S., Aguirre, F. V., Al-Attar, N., Alegria, E., Andreotti, F., Benzer, W., Breithardt, O., Danchin, N., Mario, C. D., Dudek, D., Gulba, D., Halvorsen, S., Kaufmann, P., Kornowski, R., Lip, G. Y. H., Rutten, F. (2008). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:. Eur Heart J 29: 2909-2945 [Full Text]  
• Shah, A. P., French, W. J. (2008). Physicians ... Wake Up!. J Am Coll Cardiol Intv 1: 689-691 [Full Text]  
• Vlaar, P. J., Svilaas, T., Damman, K., de Smet, B. J.G.L., Tijssen, J. G.P., Hillege, H. L., Zijlstra, F. (2008). Impact of Pretreatment With Clopidogrel on Initial Patency and Outcome in Patients Treated With Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Systematic Review. Circulation 118: 1828-1836 [Abstract] [Full Text]  
• Kramer, M. C.A., van der Wal, A. C., Koch, K. T., Ploegmakers, J. P.H.M., van der Schaaf, R. J., Henriques, J. P.S., Baan, J. Jr, Rittersma, S. Z.H., Vis, M. M., Piek, J. J., Tijssen, J. G.P., de Winter, R. J. (2008). Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention. Circulation 118: 1810-1816 [Abstract] [Full Text]  
• Gu, Y.L., Fokkema, M.L., Zijlstra, F. (2008). The Emerging Role of Thrombus Aspiration in the Management of Acute Myocardial Infarction. Circulation 118: 1780-1782 [Full Text]  
• Coller, B. S., Shattil, S. J. (2008). The GPIIb/IIIa (integrin {alpha}IIb{beta}3) odyssey: a technology-driven saga of a receptor with twists, turns, and even a bend. Blood 112: 3011-3025 [Abstract] [Full Text]  
• Antoniucci, D. (2008). Is an Occluded Artery Better Than an Open One?. J Am Coll Cardiol Intv 1: 521-523 [Full Text]  
• Niccoli, G., Giubilato, S., Russo, E., Spaziani, C., Leo, A., Porto, I., Leone, A. M., Burzotta, F., Riondino, S., Pulcinelli, F., Biasucci, L. M., Crea, F. (2008). Plasma levels of thromboxane A2 on admission are associated with no-reflow after primary percutaneous coronary intervention. Eur Heart J 29: 1843-1850 [Abstract] [Full Text]  
• Stone, G. W. (2008). Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions. Circulation 118: 552-566 [Full Text]  
• Gibson, C. M., Zorkun, C., Kunadian, V. (2008). Intracoronary Administration of Abciximab in ST-Elevation Myocardial Infarction. Circulation 118: 6-8 [Full Text]  
• Jaffe, R., Charron, T., Puley, G., Dick, A., Strauss, B. H. (2008). Microvascular Obstruction and the No-Reflow Phenomenon After Percutaneous Coronary Intervention. Circulation 117: 3152-3156 [Full Text]  
• Uretsky, B. F., Mongeon, F.-P., Eisenberg, M. J., Rinfret, S., Tomoda, H., Izumi, N., Aoki, N., Amato, J. L. Jr., Shamoon, F. E., Haft, J. I., Svilaas, T., Zijlstra, F., the TAPAS Investigators, (2008). Thrombus Aspiration during Primary Percutaneous Coronary Intervention. NEJM 358: 2639-2641 [Full Text]  
• Rihal, C. S. (2008). Drug-Eluting Stents for ST-Segment Elevation Myocardial Infarction: Treatment of Choice or Is Discretion the Better Part of Valor?. J Am Coll Cardiol Intv 1: 233-235 [Full Text]  
• Vlaar, P. J., Svilaas, T., Vogelzang, M., Diercks, G. F., de Smet, B. J., van den Heuvel, A. F., Anthonio, R. L., Jessurun, G. A., Tan, E., Suurmeijer, A. J., Zijlstra, F. (2008). A Comparison of 2 Thrombus Aspiration Devices With Histopathological Analysis of Retrieved Material in Patients Presenting With ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol Intv 1: 258-264 [Abstract] [Full Text]  
• Bates, E. R. (2008). Aspirating and Filtering Atherothrombotic Debris During Percutaneous Coronary Intervention. J Am Coll Cardiol Intv 1: 265-267 [Full Text]  
• Di Mario, C., Ferrante, G. (2008). Embolization: The "Dark Side" of Percutaneous Coronary Interventions. J Am Coll Cardiol Intv 1: 277-278 [Full Text]  
• (2008). All you need to read in the other general journals. BMJ 336: 354-355 [Full Text]  
• Vetrovec, G. W. (2008). Improving Reperfusion in Patients with Myocardial Infarction. NEJM 358: 634-637 [Full Text]  
• (2008). Does Thrombus Aspiration Improve Outcomes of Primary Percutaneous Coronary Intervention?. Journal Watch Cardiology 2008: 1-1 [Full Text]