Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) Mortality and r...
TAPAS: Background <ul><li>Myocardial perfusion after primary PCI determines clinical outcome </li></ul><ul><li>Embolizatio...
TAPAS: Methods (1) <ul><li>Single center, prospective, randomized </li></ul><ul><li>Consecutive patients with STEMI </li><...
TAPAS: Methods (2) <ul><li>Randomization  before  angiography to thrombus aspiration or conventional PCI </li></ul><ul><li...
FZ 2008-5 1071 STEMI patients randomized 535 were assigned to thrombus aspiration <ul><li>33 did not undergo PCI </li></ul...
Baseline clinical characteristics FZ 2008-6 Characteristic Thrombus aspiration N = 535 Conventional N = 536 Age, years 63 ...
Baseline angiographic characteristics FZ 2008-7 Characteristic Thrombus aspiration N = 535 Conventional N = 536 Infarct re...
Primary endpoint: Myocardial blush grade Svilaas T et al. NEJM 2008;358:557 - FZ 2008-8 P < 0.001  Patients (%) Thrombus a...
ST-segment elevation resolution Svilaas T et al. NEJM 2008;358-557 - FZ 2008-9 Patients (%) Thrombus aspiration Convention...
Myocardial blush grade and death or death/reinfarction at 30-days FZ 2008-10 Myocardial blush grade P = 0.001
TAPAS: Summary of findings at 30 days <ul><li>Thrombus aspiration results in improved myocardial reperfusion </li></ul><ul...
TAPAS one year outcome: Myocardial blush grade and death or death/reinfarction at 1 year FZ 2008-12 Myocardial blush grade...
Mortality at 1 year Log-Rank p = 0.040 *Unpublished results
Mortality or non-fatal ReMI at 1 year Log-Rank p = 0.016 *Unpublished results
TAPAS: Mortality and reinfarction at 1 year <ul><li>Myocardial blush grade predicts clinical outcome at 1 year </li></ul><...
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Zilstra Tapas Slides

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TAPAS study

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  • Zilstra Tapas Slides

    1. 1. Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) Mortality and reinfarction at 1 year F. Zijlstra, MD PhD Thoraxcenter University Medical Center Groningen, The Netherlands FZ 2008-1
    2. 2. TAPAS: Background <ul><li>Myocardial perfusion after primary PCI determines clinical outcome </li></ul><ul><li>Embolization of atherothrombotic material plays a crucial role in microvascular obstruction and impared myocardial perfusion </li></ul><ul><li>Previous trials have shown the feasibility of thrombus aspiration during primary PCI </li></ul>FZ 2008-2
    3. 3. TAPAS: Methods (1) <ul><li>Single center, prospective, randomized </li></ul><ul><li>Consecutive patients with STEMI </li></ul><ul><li>Primary endpoint </li></ul><ul><ul><li>Myocardial blush grade (core lab) </li></ul></ul><ul><li>Secondary endpoints </li></ul><ul><ul><li>ST-segment elevation resolution </li></ul></ul><ul><ul><li>30 day death and death / reinfarction </li></ul></ul><ul><ul><li>1-year death and death / reinfarction </li></ul></ul>Svilaas T et al. TAPAS - study design. Am heart J 2006;151:597 - FZ 2008-3
    4. 4. TAPAS: Methods (2) <ul><li>Randomization before angiography to thrombus aspiration or conventional PCI </li></ul><ul><li>Exclusion criteria </li></ul><ul><ul><li>Rescue PCI after thrombolysis </li></ul></ul><ul><ul><li>Life expectancy < 6 months </li></ul></ul><ul><li>Standard treatment </li></ul><ul><ul><li>Heparin, aspirin, clopidogrel, abciximab </li></ul></ul><ul><li>Intention to treat analysis </li></ul>Svilaas T et al. TAPAS - study design. Am Heart J 2006;151:597 - FZ 2008-4
    5. 5. FZ 2008-5 1071 STEMI patients randomized 535 were assigned to thrombus aspiration <ul><li>33 did not undergo PCI </li></ul><ul><li>502 underwent primary PCI </li></ul><ul><ul><li>295 underwent TA followed by </li></ul></ul><ul><ul><li>direct stenting </li></ul></ul><ul><ul><li>153 underwent TA with additional </li></ul></ul><ul><ul><ul><li>balloon dilation </li></ul></ul></ul><ul><ul><li>54 had crossover to conventional </li></ul></ul><ul><ul><li>PCI </li></ul></ul>536 were assigned to conventional PCI <ul><li>33 did not undergo PCI </li></ul><ul><li>503 underwent primary PCI </li></ul><ul><ul><li>485 underwent balloon dilation </li></ul></ul><ul><ul><li>followed by stenting </li></ul></ul><ul><ul><li>12 underwent conventional PCI </li></ul></ul><ul><ul><ul><li>with additional TA </li></ul></ul></ul><ul><ul><li>6 had crossover to TA </li></ul></ul>530 complete follow-up at 1 year 530 complete follow-up at 1 year
    6. 6. Baseline clinical characteristics FZ 2008-6 Characteristic Thrombus aspiration N = 535 Conventional N = 536 Age, years 63 ±13 63 ±13 Male gender 68% 73% Body mass index 27 ±4 27 ±4 Hypertension 33% 37% Family history 46% 45% Diabetes 11% 13% Hypercholesterolemia 24% 27% Current smoking 46% 48% Previous MI 10% 11% Total ischemic time (min) 190 (110-270) 185 (107-263)
    7. 7. Baseline angiographic characteristics FZ 2008-7 Characteristic Thrombus aspiration N = 535 Conventional N = 536 Infarct related vessel LAD 43% 43% LCX 18% 15% RCA 37% 40% Multivessel disease 66% 69% TIMI flow grade 0 or 1 55% 60% 2 19% 16% 3 26% 25% Thrombus 49% 46%
    8. 8. Primary endpoint: Myocardial blush grade Svilaas T et al. NEJM 2008;358:557 - FZ 2008-8 P < 0.001 Patients (%) Thrombus aspiration Conventional PCI
    9. 9. ST-segment elevation resolution Svilaas T et al. NEJM 2008;358-557 - FZ 2008-9 Patients (%) Thrombus aspiration Conventional PCI P < 0.001
    10. 10. Myocardial blush grade and death or death/reinfarction at 30-days FZ 2008-10 Myocardial blush grade P = 0.001
    11. 11. TAPAS: Summary of findings at 30 days <ul><li>Thrombus aspiration results in improved myocardial reperfusion </li></ul><ul><li>Myocardial blush grade predicts 30-day rates of death and reinfarction </li></ul><ul><li>Does improved myocardial reperfusion translate into clinical benefit at 1 year? </li></ul>FZ 2008-11 ?
    12. 12. TAPAS one year outcome: Myocardial blush grade and death or death/reinfarction at 1 year FZ 2008-12 Myocardial blush grade P = 0.001
    13. 13. Mortality at 1 year Log-Rank p = 0.040 *Unpublished results
    14. 14. Mortality or non-fatal ReMI at 1 year Log-Rank p = 0.016 *Unpublished results
    15. 15. TAPAS: Mortality and reinfarction at 1 year <ul><li>Myocardial blush grade predicts clinical outcome at 1 year </li></ul><ul><li>Thrombus aspiration results in a lower mortality and combined mortality and non-fatal reinfarction at 1 year </li></ul>FZ 2008-15

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