TASTE Trial – Review

TASTE Trial – Review

TASTE trial (Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction) was a multicenter, prospective, randomized open label study which enrolled 7244 patients from the Swedish Coronary Angiography and Angioplasty Registry [1]. The patients with ST elevation myocardial infarction were assigned to either percutaneous coronary intervention (PCI) with manual thrombus aspiration or PCI alone. Primary endpoint of the study was 30 day all-cause mortality. Mortality was 2.8% in the thrombus aspiration group and 3.0% in the PCI only group, which was not a statistically significant difference. There were no statistically significant differences in 30 day rehospitalization, stent thrombosis or rates of stroke/neurological complications at discharge.

In a prior trial INFUSE-AMI, manual thrombus aspiration was not found to be beneficial in those undergoing primary PCI with bivalirudin anticoagulation. Infarct size at 30 days was significantly reduced by bolus intracoronary abciximab [2]. In the TAPAS study, thrombus aspiration was shown to produce better reperfusion and clinical outcome at 30 days. One year outcome in terms of death and non-fatal re-infarction was better in the thrombus aspiration group [4]. But the number of patients in TAPAS trial was much smaller compared to TASTE trial.

Some of the limitations of the TASTE trial were that it was an open label study and there was neither adjudication of events nor blinded review of angiograms. One year follow up data of TASTE trial showed that routine thrombus aspiration before PCI in STEMI patients did not reduce the all-cause mortality or the composite of all cause mortality, rehospitalization for myocardial infarction or stent thrombosis at 1 year [5].

An individual patient meta analysis from Thrombectomy Trialists Collaboration also came to a similar conclusion [6]. The meta-analysis included only large trials with more than 1000 participants. The trials included were TAPAS, TASTE and TOTAL, with altogether 18,306 patients who underwent PCI. There were no significant differences in recurrent myocardial infarction, stent thrombosis, heart failure or target vessel revascularization. In the subgroup with high thrombus burden, there was a trend towards reduced cardiovascular death, and increased stroke/transient ischemic attack.

References

1. Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, Aasa M, Angerås O, Calais F, Danielewicz M, Erlinge D, Hellsten L, Jensen U, Johansson AC, Kåregren A, Nilsson J, Robertson L, Sandhall L, Sjögren I, Ostlund O, Harnek J, James SK; TASTE Trial. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013 Oct 24;369(17):1587-97.
2. Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, Ochala A, Carlton TW, Cristea E, Wolff SD, Brener SJ, Chowdhary S, El-Omar M, Neunteufl T, Metzger DC, Karwoski T, Dizon JM, Mehran R, Gibson CM; INFUSE-AMI Investigators. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA. 2012 May 2;307(17):1817-26.
3. Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008 Feb 7;358(6):557-67.
4. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008 Jun 7;371(9628):1915-20.
5. Lagerqvist B, Fröbert O, Olivecrona GK, Gudnason T, Maeng M, Alström P, Andersson J, Calais F, Carlsson J, Collste O, Götberg M, Hårdhammar P, Ioanes D, Kallryd A, Linder R, Lundin A, Odenstedt J, Omerovic E, Puskar V, Tödt T, Zelleroth E, Östlund O, James SK. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med. 2014 Sep 18;371(12):1111-20.
6. Jolly SS, James S, Džavík V, Cairns JA, Mahmoud KD, Zijlstra F, Yusuf S, Olivecrona GK, Renlund H, Gao P, Lagerqvist B, Alazzoni A, Kedev S, Stankovic G, Meeks B, Frøbert O. Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration. Circulation. 2017 Jan 10;135(2):143-152.