In September, a team of Swedish researchers released trial results showing no difference in 30-day all-cause mortality rates for patients with ST-elevation myocardial infarction (STEMI), a severe form of heart attack, who underwent thrombus aspiration prior to percutaneous coronary intervention compared with patients who underwent PCI alone.
The aspiration procedure entails inserting a thin plastic tube into a coronary artery and sucking the thrombus, or clot, into a syringe. That's followed by PCI, where the plaque-clogged artery is pressed open with a balloon catheter and a stent is implanted to hold the expanded vessel walls in place.
The popularity of thrombus aspiration has grown significantly since 2008, when a randomized trial known by the acronym TAPAS—thrombus aspiration during primary percutaneous coronary intervention—suggested mortality rates could be improved by aspirating clots prior to PCI. The American Heart Association and the American College of Cardiology in 2009 recommended aspiration thrombectomy as “reasonable for patients undergoing primary PCI” based on the results of that trial.
But this latest trial, dubbed TASTE—thrombus aspiration during ST-segment elevation myocardial infarction—and published last month in the New England Journal of Medicine, is casting doubts on whether thrombus aspiration should be an automatic add-on for PCIs and whether the uncertain outcomes associated with the procedure justify the additional costs.
“Maybe aspiration is not as important as we thought,” said Dr. Ralph Brindis, clinical professor of medicine at the University of California at San Francisco, and past president of the American College of Cardiology.
The issue has financial implications for hospitals that must foot the bill for the thrombus aspiration catheters, which cost about $500 to $800 apiece. Since treatment for most patients undergoing catheterization is paid for under the DRG system, the cost of related devices, such as aspiration catheters, comes out of hospitals' set payment for PCI.