title: Effect of aspiration thrombectomy on microvascular obstruction in NSTEMI patients: the TATORT-NSTEMI trial.
abstract: BACKGROUND
  Aspiration thrombectomy in ST-segment elevation myocardial infarction is recommended by current guidelines based on several randomized trials. There are no trials assessing thrombectomy in non-ST-segment elevation myocardial infarction (NSTEMI) patients.
  
  
  OBJECTIVE
  The TATORT-NSTEMI (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non-ST-Elevation Myocardial Infarction) trial sought to assess the effect of aspiration thrombectomy on microvascular injury in patients with NSTEMI compared with standard percutaneous coronary intervention (PCI).
  
  
  METHODS
  This prospective, controlled, multicenter study randomized 440 patients to adjunctive thrombectomy (n = 221) compared with conventional PCI (n = 219) in NSTEMI patients with thrombus-containing lesions. The primary endpoint of the extent of microvascular obstruction (MO) in the percentage of left ventricular mass (%LV) was assessed by cardiac magnetic resonance imaging within 4 days. Secondary endpoints included infarct size, myocardial salvage index, and angiographic parameters including myocardial blush grade and Thrombolysis In Myocardial Infarction 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 of MO was not different between the thrombectomy and the standard PCI group with 2.0%LV (interquartile range [IQR]: 0.8 to 4.1) versus 1.4%LV (IQR: 0.7 to 2.6) (p = 0.17). Similarly, no significant differences were observed for infarct size (8.6%LV; IQR: 4.0 to 14.7 vs. 7.4%LV; IQR: 4.1 to 13.1; p = 0.46), myocardial salvage index (63.3; IQR: 35.4 to 87.2 vs. 65.6; IQR: 46.9 to 82.6; p = 0.45), or angiographic parameters such as blush grade (p = 0.63) and Thrombolysis In Myocardial Infarction flow grade (p = 0.66). Clinical follow-up at 6 months revealed no differences in the combined clinical endpoints (p = 0.22).
  
  
  CONCLUSIONS
  Aspiration thrombectomy in conjunction with PCI in NSTEMI with a thrombus-containing lesion does not lead to a reduction in MO. (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non-ST-Elevation Myocardial Infarction [TATORT-NSTEMI]; NCT01612312).
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany; Medical Clinic II, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany. Electronic address: holger.thiele@uksh.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany; Heart Center Bad Segeberg, Bad Segeberg, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: Institut für Herzinfarktforschung, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany; Medical Clinic II, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Internal Medicine III, University of Saarland, Homburg, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Scheller
authors.affiliation: Department of Cardiology, Zentralklinik Bad Berka, Germany.
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.affiliation: Department of Cardiology/Cardiovascular Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Geisler
authors.affiliation: Department of Cardiology/Cardiovascular Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.affiliation: Department of Internal Medicine II, Klinikum Frankfurt/Oder, Frankfurt/Oder, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gunkel
authors.affiliation: Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Leonhard
authors.initials: L
authors.lastname: Bruch
authors.affiliation: Department of Internal Medicine I, University of Leipzig, Leipzig, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Klein
authors.affiliation: Department of Internal Medicine I, University of Leipzig, Leipzig, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Pfeiffer
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*
keywords: cardiac magnetic resonance imaging; microvascular obstruction; non–ST-segment elevation myocardial infarction; perfusion; thrombectomy