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TAPAS at 1 year: evidence for pre-PCI thrombus aspiration
The Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction (TAPAS) trial compared stenting for acute ST-elevation myocardial infarction with or without prior use of the Medtronic Export aspiration catheter. In the original trial, more than 1000 patients were randomised to bare metal stenting with or without thrombus aspiration (with predilatation being used only as necessary). The authors found that thrombus aspiration improved myocardial blush grade (17.1% vs 26.3%; p<0.001) and ST-segment resolution (56.6% vs 44.2%; p<0.001); would these benefits be sustained at 1 year?
At 12–month follow-up, cardiac death was 3.6% (19/535 patients) in the thrombus aspiration group and 6.7% (36/535) in the conventional PCI group (p = 0.020). Cardiac death or non-fatal reinfarction occurred in 5.6% (30/535) of patients in the thrombus aspiration group and 9.9% (53/536) of patients in the conventional PCI group (p = 0.009). These convincing results have led to many calling TAPAS a “practice-changing” trial.
Incomplete myocardial reperfusion occurs in about one-third of primary PCIs and negates any potential benefit of the procedure. Previous trials of filter devices in primary PCIs may have failed as debris and vasoactive agents got through the device; the former, if not necessarily the latter, can be avoided by use of an aspiration catheter. Furthermore, their ease of use and cost-effectiveness means that aspiration catheters are likely to gain widespread use in clinical practice with relative ease. However, the search for further treatments must also target the other causes of incomplete reperfusion—ischaemia–reperfusion injury and injury to the coronary microcirculation.
▸ Vlaar PJ, Svilaas T, van der Horst IC, . Cardiac death and reinfarction after 1 year in the thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study (TAPAS): a 1-year follow-up study. Lancet 2008;371:1915–20.
Facilitated PCI in STEMI
The Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) study was an international, double-blind, …