1. Uppsala Clinical Research Center
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

2. Background
Intracoronary thrombus aspiration may reduce distal embolization and improve reperfusion
No previous randomized trial on thrombus aspiration has been powered for hard endpoints
Current ESC recommendation: class IIa with a level of evidence B

3. / Swedish registry data
TAPAS
/ Swedish registry data
TA+PCI (N=3 666)
PCI alone (N=16 417)
HR (95% CI): 1.21 ( )
Data
Vlaar, P.J. et al. The Lancet 2008; 371:
Fröbert, O. et al. Int J Cardiol. 2010; 145:572-3

4. Methods (1) All 29 Swedish, 1 Icelandic and 1 Danish PCI center
Inclusion criteria
STEMI and ability to provide oral consent
<24 h symptoms
correspondence between ECG and angio findings
Exclusion criteria
need for emergency CABG
age <18 years
previous randomization in TASTE
1:1 randomization to manual thrombus aspiration and PCI vs. PCI alone

5. Methods (2) Endorsed aspiration catheters
Eliminate (Terumo), Export (Medtronic) and Pronto (Vascular Solutions)
Anticoagulation and platelet inhibition according to current guideline recommendations
Primary endpoint
time to all-cause death at 30 days
Secondary endpoints
time to rehospitalization with reinfarction at 30 days
time to stent thrombosis at 30 days

6. Methods (3)
TASTE introduces the Registry-based Randomized Clinical Trial (RRCT) concept
Online health quality registries (SCAAR and SWEDEHEART) serve as on-line platforms for:
randomization
case record forms
follow-up

7. TASTE trial enrollment flow chart
Enrolled in Denmark
N=247
All patients with STEMI in Sweden and Iceland undergoing
primary or rescue PCI. N= *)
Enrolled in TASTE
N=7259
Not enrolled
N=4697
Erroneous enrollments
N=15
Randomized in TASTE
N=7244
No patients (0) were lost to follow-up of the primary endpoint!
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

8. TASTE and previous studies

9. Baseline clinical characteristics

10. Baseline procedural characteristics

11. Post randomization characteristics (1)

12. Post randomization characteristics (2)

13. 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

14. Reinfarction at 30 days HR 0.61 (0.34 - 1.07), P=0.09
Per protocol analysis based on actual treatment:
HR 0.67 ( ), P=0.19

15. Additional results

16. p

17. TASTE vs. TAPAS

18. TASTE vs. TAPAS

19. Conclusions
This large, prospective, registry-based randomized clinical trial showed:
no reduction of mortality at 30 days
no significant reduction of hospitalization for MI or of stent thrombosis at 30 days
no reduction of other important clinical endpoints during hospitalization
Our findings leave little role for manual thrombus aspiration as a routine adjunct to PCI in STEMI

20. Participating centers
Steering committee
Stefan K. James, MD, PhD (chair)
Bo Lagerqvist, MD, PhD
Göran K. Olivecrona, MD, PhD
Michael Mæng, MD, PhD (DENMARK)
Thórarinn Gudnason, MD, PhD (ICELAND)
Ole Fröbert, MD, PhD (PI)
Participating centers
Karolinska Institutet, Södersjukhuset, Sweden.
Karolinska Solna and Huddinge Hospitals, Sweden.
Karolinska University Hospital, Sweden.
Kristianstad Hospital, Sweden.
Sahlgrenska University Hospital, Gothenburg, Sweden.
Skövde Hospital, Sweden.
Sunderby Hospital, Sweden.
Sundsvall Hospital, Sweden.
Trollhättan Hospital, Sweden.
Umeå University Hospital, Sweden.
Uppsala Clinical research center, Sweden.
Västerås Hospital, Sweden.
Örebro University Hospital, Sweden.
Landspitali University Hospital, Reykjavik, Iceland.
Aarhus University Hospital, Denmark.
Borås Hospital, Sweden.
Capio, S:t Görans Hospital, Sweden.
Danderyd University Hospital, Sweden.
Eskilstuna Hospital, Sweden.
Falun Hospital, Sweden.
Gävle Hospital, Sweden.
Halmstad Hospital, Sweden.
Helsingborg Hospital, Sweden.
Jönköping Hospital, Sweden.
Linköping University Hospital, Sweden.
Lund University Hospital, Sweden.
Malmö Hospital, Sweden.
Kalmar Hospital, Sweden.
Karlskrona Hospital, Sweden.
Karlstad Hospital, Sweden.