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ARTICLE CONTRIBUTORS

Professor Martin T Rothman (Barts Health NHS Trust, London, United Kingdom)

Clinical Articles, Lead Article

TASTE and PRAMI presented at ESC

Results from the TASTE and the PRAMI trials were presented during a hotline session at this year’s European Society of Cardiology congress, published simultaneously in the New England Journal of Medicine.1,2

TASTE results

Dr. Ole Fröbert (Örebro, Sweden) presented the main results at 30 days of the TASTE (Thrombus aspiration in ST-Elevation myocardial information in Scandinavia) trial. This prospective, multicentre trial is based on the national Swedish Coronary Angiography and Angioplasty Registry (SCAAR) platform. The investigators randomised 7,244 ST-elevation myocardial infarction (STEMI) patients to either manual thrombus aspiration followed by primary percutaneous coronary intervention (PPCI) or to PPCI alone. The primary endpoint was all-cause mortality at 30 days, which was 2.8% in the thrombus aspiration arm and 3.0% in the conventional PCI arm (p = 0.63).

The rate of stent thrombosis was borderline significant at 30 days (0.2% vs 0.5% respectively (HR 0.47 (0.20 – 1.02); p = 0.06). Also the rate of rehospitalisation due to reinfarction (0.5% vs 0.9% respectively (HR 0.61 (0.34-1.07); p = 0.09) might be a signal to a health economic benefit at a later stage.

A number of patients were not randomised (4,697 of 11,709 STEMI patients), with the investigators reporting reasons including

  • 11% aspiration considered inappropriate,
  • 7% thrombus aspiration considered indicated
  • 28% other reasons.

Mortality in those patients excluded was over 10% at 30 days.

PRAMI results

Dr David Wald (London, United Kingdom) presented the primary outcomes of the PRAMI (Preventive Angioplasty in Acute Myocardial Infarction) trial. Counter to current belief and guidelines, the trial showed that in patients with STEMI and multi-vessel disease, preventative PCI of non-culprit stenosis (>50%) at the time of PPCI of the culprit lesion had significantly lower event rates compared to PCI of the culprit lesion alone.

The primary endpoint, a combined rate of cardiac death, nonfatal myocardial infarction, or refractory angina, was reduced by 65% over 23 months (HR 0.35 (0.21-0.58); p <0.001).

Look out for further details in an upcoming BJC podcast, which will be featured soon at http://bjcardio.co.uk/extra

References

1. Fröbert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-Elevation Myocardial Infarction. New Eng J Med 2013. http://dx.doi.org/10.1056/NEJMoa1308789

2. Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction. New Eng J Med 2013. http://dx.doi.org/10.1056/NEJMoa1305520

Published on: September 18, 2013

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