New catheter technique doubles survival after heart attack
Aspiration technique avoids need for balloon dilatation and is cheap and easy to use
Friday, 06 June 2008
Treating a heart attack with a catheter technique in addition to a coronary stent lowers the death rate after a year, indicates research in The Lancet.
Currently, percutaneous coronary infusion (PCI) is the preferred treatment for acute heart attack, and includes balloon dilatation of the blocked artery followed by implantation of a coronary stent.
But it can be complicated by the risk of material from the ruptured plaque breaking off into the bloodstream, reducing blood flow to the affected area of the heart muscle.
But this can be removed using a thrombus aspiration catheter, obviating the need for balloon dilatation and allowing the stent to be directly implanted into the blood vessel.
Dutch researchers tracked the progress of patients taking part in the Thrombus Aspiration during Percutaneous coronary infusion in Acute myocardial infarction Study (TAPAS) trial at one year.
In this, participants had been randomly assigned to either thrombus aspiration (535 patients) or conventional balloon dilatation followed by stent implantation (536 patients).
The researchers found that the rate of cardiac death at one year was 3·6% in the thrombus aspiration group, and 6·7% in the conventionally treated group.
The combined rate of cardiac death or non-fatal heart attack was 5·6% of patients in the thrombus aspiration group and almost one in 10 (9.9%) in the conventional treatment group.
“Compared with conventional PCI, thrombus aspiration before stenting.... results in improved myocardial perfusion and seems to improve clinical outcome 1 year after PCI for acute heart attack,” they conclude.
“Based on these results, thrombus aspiration will be increasingly utilised in routine clinical practice in the Netherlands and elsewhere in the world,” they assert.
In an accompanying Commentary, Dr Francesco Burzotta and Professor Filippo Crea, of the Institute of Cardiology in Rome, Italy, say: “The notion that, during primary PCI, aspiration is better than predilatation will probably soon influence clinical guidelines.”
Thrombus aspirating catheters are cheap and easy to use, lending themselves to widespread use, they add.
The Lancet 2008; 371: 1915-20; 1889.