title: Impact of thrombus aspiration during ST-Elevation Myocardial Infarction: a six month composite endpoint and risk of stroke analyses of the TASTE trial.
abstract: BACKGROUND
  Routine thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the "A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI" (TOTAL) trial. We aimed to analyse a similar endpoint in "The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia" (TASTE) trial up to 180 days.
  
  
  METHODS
  In TASTE, 7244 patients with STEMI were randomised to thrombus aspiration followed by PCI or to PCI alone. We analysed the quadruple composite endpoint of cardiovascular death, cardiogenic shock, rehospitalisation for myocardial infarction, or new hospitalisation for heart failure. Furthermore, an extended net-benefit composite endpoint including stent thrombosis, target vessel revascularization or stroke within 180 days was analysed.
  
  
  RESULTS
  The primary quadruple composite endpoint occurred in 8.7 % (316 of 3621) in the thrombus aspiration group compared to 9.3 % (338 of 3623) in the PCI alone group (hazard ratio (HR), 0.93; 95 % confidence interval (CI); 0.80 - 1.09, P = 0.36) and the extended net-benefit composite endpoint in 12.0 % (436) vs. 13.2 % (479) (HR, 0.90; 95 % CI; 0.79 - 1.03, P = 0.12). Stroke within 30 days occurred in 0.7 % (27) vs. 0.7 % (24) (HR, 0.89; 95 % CI; 0.51-1.54, P = 0.68).
  
  
  CONCLUSIONS
  A large and an extended composite endpoint analysis from the TASTE trial did not demonstrate any clinical benefit of routine thrombus aspiration during PCI in patients with STEMI. There was no evidence of an increased risk of stroke with thrombus aspiration.
authors.affiliation: Department of Cardiology, Skane University Hospital, Lund University, Lund, 221 85, Sweden. goran.olivecrona@gmail.com.
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.affiliation: Department of Cardiology, Örebro University, Faculty of Health, Örebro, Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Fröbert
authors.affiliation: Department of Cardiology, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Thórarinn
authors.initials: T
authors.lastname: Gudnason
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Truls
authors.initials: T
authors.lastname: Råmunddal
authors.affiliation: PCI Unit, Sunderby Hospital, Sunderby, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Haupt
authors.affiliation: Department of Cardiology, Örebro University, Faculty of Health, Örebro, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kellerth
authors.affiliation: Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
authors.forename: Jason
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sarno
authors.affiliation: Department of Cardiology, Karolinska Institutet, Stockholm and Sundsvall Hospital, Sundsvall, Sweden.
authors.forename: Jens
authors.initials: J
authors.lastname: Jensen
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Ollie
authors.initials: O
authors.lastname: Östlund
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
mesh_terms: D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries; D012770:Shock, Cardiogenic / Q000209:etiology; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D017131:Thrombectomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
keywords: Myocardial infarction; PCI; STEMI; Thrombus aspiration