FZ 2008-1.ppt

Thrombus aspiration during primary PCI FZ 2008-1 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 2008-2 TAPAS: Background Myocardial perfusion after primary PCI determines clinical outcome Embolization of atherothrombotic material plays a crucial role in microvascular obstruction and impared myocardial perfusion Previous trials have shown the feasibility of thrombus aspiration during primary PCI Svilaas T et al. TAPAS - study design. Am heart J 2006;151:597 - FZ 2008-3 TAPAS: Methods (1) Single center, prospective, randomized Consecutive patients with STEMI Primary endpoint Myocardial blush grade (core lab) Secondary endpoints ST-segment elevation resolution 30 day death and death / reinfarction 1-year death and death / reinfarction Svilaas T et al. TAPAS - study design. Am Heart J 2006;151:597 - FZ 2008-4 TAPAS: Methods (2) Randomization before angiography to thrombus aspiration or conventional PCI Exclusion criteria Rescue PCI after thrombolysis Life expectancy 6 months Standard treatment Heparin, aspirin, clopidogrel, abciximab Intention to treat analysis FZ 2008-5 1071 STEMI patients randomized 535 were assigned to thrombus aspiration 33 did not undergo PCI 502 underwent primary PCI 295 underwent TA followed by direct stenting 153 underwent TA with additional balloon dilation 54 had crossover to conventional PCI 536 were assigned to conventional PCI 33 did not undergo PCI 503 underwent primary PCI 485 underwent balloon dilation followed by stenting 12 underwent conventional PCI with additional TA 6 had crossover to TA 530 complete follow-up at 1 year 530 complete follow-up at 1 year FZ 2008-6 Baseline clinical characteristics 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 Hy