SAN FRANCISCO, CA – Aspiration thrombectomy in non-ST-segment-elevation MI (NSTEMI) patients with detectable thrombus failed to reduce the presence and extent of myocardial obstruction when compared with PCI alone, according to the results of a new study.

In TATORT-NSTEMI , 440 NSTEMI patients with ischemic symptoms and relevant thrombus in the identified culprit lesions were randomized to aspiration thrombectomy plus PCI or PCI alone. All patients had at least a "small-size" thrombus in the lesion as assessed by a TIMI thrombus grade score. Inclusion criteria stated that the last ischemic symptom had to occur within 72 hours of randomization.

The presence and extent of microvascular obstruction measured by cardiac MRI on days 1 to 4 failed to improve among patients randomized to aspiration thrombectomy when compared with PCI alone. There was no benefit in any of the predefined subgroups, no improvement in myocardial blush grade, and no improvement in clinical outcomes measured at six months.

The study was presented this week at TCT 2013 by Dr Holger Thiele (University of Leipzig Heart Center, Germany). In presenting the results, Thiele said the use of thrombectomy has a class IIa (level of evidence B) recommendation from the European Society of Cardiology and the American College of Cardiology/American Heart Association for use in STEMI, but there is no evidence to support its use in NSTEMI patients.

The TATORT-NSTEMI trial was funded by unrestricted grants from Terumo and Lilly. Thiele reports research funding from Terumo, Lilly, the Medicines Company, Maquet Cardiovascular, and Teleflex Medical and speaking honoraria from Lilly, AstraZeneca, Daiichi Sankyo, Boehringer Ingelheim, Maquet Cardiovascular, and the Medicines Company.


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