Thrombectomie Systématique dans le SUS ST! Ne sert à rien! C EST EXACT (René Koning-St Hilaire-Rouen)

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1 Thrombectomie Systématique dans le SUS ST! Ne sert à rien! C EST EXACT (René Koning-St Hilaire-Rouen)

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3 DU JOUR AU LENDEMAIN LA FRANCE ENTIERE THROMBO-ASPIRE SYSTEMATIQUEMENT! > 90 % de ABCX!

4 ROUTINE THROMBECTOMY IN PCI FOR ACUTE ST-SEGMENT-ELEVATION MYOCARDIAL INFARCTION A Randomized Trial (215 pts), scintigraphy «Thrombectomy performed as routine therapy in primary PCI for STEMI does not increase myocardial salvage. The study suggests a possible DELETERIOUS EFFECT RESULTING IN AN INCREASED FINAL INFARCT SIZE and does not support the use of thrombectomy in unselected primary PCI pts» A. Kaltofdt, CIRCULATION 2006;114; 40_47

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6 MANUELLE et MECANIQUE Randomisée JACC, vol 5, no: 12, 2012

7 G Stone, JAMA 2012 vol 307, No 17

8 EFFET + de l ABCX IC G Stone, JAMA 2012 vol 307, No 17

9 Positive si Thrombus Angiographique Lorgis Archives of Cardiovascular Disease 2010 G De Luca, E Pio Navarese, H Suryapranata Int J Cardiol 2012

10 Kaplan Meier survival curves for adjusted cumulative mortality in thrombectomy and nonthrombectomy groups. Newcastle Noman A et al. Eur Heart J 2012;33: Published on behalf of the European Society of Cardiology. All rights reserved. The Author For permissions please journals.permissions@oup.com

11 Kaplan Meier survival curves for adjusted cumulative mortality in the thrombectomy and nonthrombectomy groups according to the total ischaemic time. < 180 min Noman A et al. Eur Heart J 2012;33: Published on behalf of the European Society of Cardiology. All rights reserved. The Author For permissions please journals.permissions@oup.com

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13 UCR Uppsala Clinical Research Center Thrombus Aspiration in ST- Elevation myocardial infarction in Scandinavia (TASTE trial) Main results at 30 days Ole Fröbert, MD, PhD - on behalf of the TASTE investigators Departement of Cardiology Örebro University Hospital Sweden

14 TASTE trial enrollment flow chart Enrolled in Denmark N=247 All patients with STEMI in Sweden and Iceland undergoing primary or rescue PCI. N= * ) Erroneous enrollments N=15 Enrolled in TASTE N=7259 Randomized in TASTE N=7244 Not enrolled N=4697 N=3621 assigned to thrombus aspiration N=3623 assigned to conventional PCI N=3399 underwent thrombus aspiration N=222 underwent conventional PCI N=3445 underwent conventional PCI N=178 underwent thrombus aspiration N=1162 underwent thrombus aspiration N=3535 underwent conventional PCI N=3621 were followed up N=3623 were followed up N=1162 were followed up N=3535 were followed up

15 TASTE and previous studies TASTE TAPAS JETSTENT AIMI INFUSE-AMI VAMPIRE PREPARE Chevalier Kaltoft MUSTELA X AMINE ST PIHRATE EXPIRA DEAR-MI Liistro Number of patients

16 All-cause mortality at 30 days HR 0.94 ( ), P=0.63 Per protocol analysis based on actual treatment: HR 0.88 ( ), P=0.38

17 Reinfarction at 30 days HR 0.61 ( ), P=0.09 Per protocol analysis based on actual treatment: HR 0.67 ( ), P=0.19

18 Additional results Randomized in TASTE Not randomized in TASTE PCI Only Thrombus Aspiration Point Estimate (95% confidence interval) P Value PCI Only Thrombus Aspiration 30 days All cause death or myocardial infarction - no. (%) 140 (3.9) 121 (3.3) HR 0.86 ( ) (11.6) 134 (11.8) Stent thrombosis - no. (%) 19 (0.5) 9 (0.2) HR 0.47 ( ) (0.5) 5 (0.4) Target vessel revascularization - no. (%) 76 (2.2) 63 (1.8) HR 0.83 ( ) (2.3) 30 (2.6) Target lesion revascularization - no. (%) 57 (1.6) 43 (1.2) HR 0.75 ( ) (1.8) 25 (2.2) Index hospitalization Stroke or neurological complication - no. (%) 18 (0.5) 19 (0.5) OR 1.06 ( ) (0.9) 12 (1.0) Perforation or tamponade - no.(%) 14 (0.4) 13 (0.4) OR 0.93 ( ) (0.4) 7 (0.6) Heart failure - no.(%) 234 (6.5) 245 (6.8) OR 1.05 ( ) (10.0) 125 (10.8) Left ventricular function - no. (%) 0.33 Moderately reduced, LVEF 30-39% 495 (13.7) 526 (14.5) 523 (14.8) 190 (16.4) Severely reduced, LVEF <30% 157 (4.3) 137 (3.8) 255 (7.2) 102 (8.8)

19 TASTE vs. TAPAS

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22 LIMITES La Marque de l «ASPIRATEUR..!» La «manière de faire» Critères de jugement: Clinique (mortalité) Troponines, ECG (régression sus ST), Echo, IRM (date), Scintigraphie Thrombectomie manuelle ou mécanique(!) Environnement antithrombotique et notamment AntiGP IIb-IIIa

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24 36 ans, Tabac, vu à H2

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36 Thromboaspiration

37 Et la thromboaspiration

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44 TIMI III-BLUSH III avec petits ballons, la thrombectomie, la chimie..

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47 Ne thromboaspire jamais de manière sytématique! Sauf et peut être si : Le Pt est vu tôt Le Pt est jeune L aspirateur n est pas trop gros pour l artère. Du thrombus visible angiographiquement Très probablement avec des antigp IIb-IIIa en Intra-Coronaire N oublies jamais : TIMI III-Blush III