Effect of Aspiration Thrombectomy on Microvascular Obstruction in NSTEMI Patients: The TATORT-NSTEMI Trial

Study Questions:

What is the effect of aspiration thrombectomy on microvascular injury in patients with non–ST-segment elevation myocardial infarction (NSTEMI) in comparison to standard percutaneous coronary intervention (PCI)?

Methods:

TATORT-NSTEMI, a prospective, controlled, multicenter study randomized 440 patients to adjunctive thrombectomy (n = 221) in comparison to conventional PCI (n = 219) in NSTEMI patients with thrombus-containing lesions. The primary endpoint extent of microvascular obstruction (MO) in percent of left ventricular mass (%LV) was assessed by cardiac magnetic resonance (CMR) imaging within 4 days. Secondary endpoints included infarct size, myocardial salvage index, and angiographic parameters including myocardial blush grade and Thrombolysis in Myocardial Infarction (TIMI)-flow grade. The combined clinical endpoint consisted of death, reinfarction, target vessel revascularization, and new congestive heart failure within 6 months.

Results:

The primary endpoint MO was not different between the thrombectomy and the standard PCI group with 2.0%LV (interquartile range [IQR], 0.8-4.1) versus 1.4%LV (IQR, 0.7-2.6); p = 0.17. Similarly, no significant differences were observed for infarct size (8.6%LV; IQR, 4.0-14.7 vs. 7.4%LV; IQR, 4.1-13.1; p = 0.46), myocardial salvage index (63.3; IQR, 35.4; 87.2 vs. 65.6; IQR, 46.9; 82.6; p = 0.45), or angiographic parameters such as blush grade (p = 0.63) or TIMI-flow grade (p = 0.66). Clinical follow-up at 6 months revealed no differences in the combined clinical endpoint (p = 0.22).

Conclusions:

The authors concluded that aspiration thrombectomy in conjunction with PCI in NSTEMI with thrombus-containing lesion does not lead to a reduction in MO.

Perspective:

This study reports that aspiration thrombectomy in patients with NSTEMI with thrombus-containing lesions in the infarct-related artery did not reduce the extent of MO in comparison to standard PCI without thrombectomy, which is corroborated by a lack of benefit in secondary endpoints. The routine use of aspiration thrombectomy in patients with NSTEMI with thrombus-containing lesions is not indicated.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure

Keywords: Myocardial Infarction, Thrombosis, Thrombectomy, Heart Failure, Magnetic Resonance Spectroscopy, Angioplasty, Balloon, Coronary


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