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TAPAS: Thrombus aspiration during PCI assists restoration of myocardial blush
Improved blush was also a good predictor of clinical outcomes at 30 days.
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CHICAGO — Aspirating thrombotic material during primary percutaneous coronary intervention may assist in restoration of adequate blood flow in patients with ST-elevation myocardial infarction, Felix Zijlstra, MD, PhD, said during a late-breaking clinical trial talk this morning.
“It is quite clear that myocardial blush grade is a principal surrogate endpoint for mortality, and is an excellent predictor of outcome at one year,” Zijlstra, a professor of medicine at the University Medical Center Groningen in The Netherlands, said. He presented the data from the Thrombus Aspiration During Percutaneous Coronary Intervention in Acute MI (TAPAS) trial at the 2008 Society of Coronary Angiography and Interventions/American College of Cardiology i2 Summit this morning.
Patients in the TAPAS trial received either conventional PCI (n=536) or PCI assisted by thrombus aspiration (n=535). Myocardial blush grade scores of zero or one occurred in 26% of patients receiving conventional PCI and in 17% of patients receiving thrombus aspiration. Complete ST-segment elevation resolution occurred in 44.2% of the PCI group and 56.6% of patients receiving thrombus aspiration.
Although the results were not homogeneous across all covariates, myocardial blush score was a good predictor of clinical outcomes at 30 days. Mortality was 5.2% in patients with myocardial blush scores of zero or one, 2.9% for myocardial blush scores of two, and 1.0% with a blush score of three (P,.01). In addition, adverse cardiac events were 14.1% in patients with blush scores of one or zero, 8.8% for scores of two, and 4.2% for scores of three. – by Eric Raible
For more information:
- Zijlstra F. Thrombus aspiration during coronary angioplasty for acute myocardial infarction. Session 2404-5. Presented at: Society of Coronary Angiography and Interventions in partnership with the American College of Cardiology i2 Summit ; Mar. 29-Apr. 1, 2008; Chicago.
Should TAPAS change the way we practice? It is underpowered for the clinical endpoints, but the findings are fascinating and are easy to randomize outside of an independent core lab. Is this enough data for us to embrace simple aspiration thrombectomy in STEMI? I am not sure I can answer that, but I would love to see more data on increased infarct, and a 10,000-patient trial powered for mortality.
– David A. Cox, MD
Cardiologist, Lehigh Valley Hospital, Allentown, Pa.