Vlaar PJ et al. (2008) Cardiac death and reinfarction after 1 year in the Thombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS): a 1-year follow-up study. Lancet 371: 1915–1920

Reperfusion of viable myocardium following percutaneous coronary intervention (PCI) is frequently suboptimal—microvascular obstruction can occur following embolization of atherothrombotic material from the culprit lesion into the distal vasculature. Thrombus aspiration can establish antegrade flow before revascularization, and improves various measures of myocardial reperfusion, but whether aspiration is also associated with a survival benefit is not known. The TAPAS study, published recently in the Lancet, has now shown preliminary evidence of a long-term clinical benefit for thrombus aspiration before PCI.

Conventional treatment was compared with thrombus aspiration in 1,071 consecutive patients with ST-segment elevation myocardial infarction. Before angioplasty, patients were randomly assigned to undergo either thrombus aspiration with the Export® XT aspiration catheter (Medtronic, Minneapolis, MN; n = 535) or conventional treatment (n = 536). At 1 year, significantly fewer deaths from cardiovascular causes had occurred in the aspiration group than in the conventional-therapy group (19 versus 36 patients, or 3.6% versus 6.7%; hazard ratio 1.93, 95% CI 1.11–3.37). The combined end point of cardiac-related death or nonfatal reinfarction occurred in 30 patients (5.6%) treated with aspiration compared with 56 patients (9.9%) who underwent conventional treatment (hazard ratio 1.81, 95% CI 1.16–2.84; P = 0.009).

Thrombus aspiration before PCI seems to improve clinical outcomes at 1 year; however, further investigation with sufficiently powered studies is needed.