THURSDAY, June 5 (HealthDay News) -- Vacuuming out loose pieces
of clots before artery-opening treatment of a heart attack reduced
the one-year death rate by nearly half in a Dutch trial, a result
that cardiologists said could change medical practice.
The latest data on the trial of a technique called thrombus
aspiration showed that just 19 of 535 heart attack victims -- 3.6
percent -- given the treatment died within a year, compared to 36
deaths among the 536 people -- 6.7 percent -- given conventional
treatment.
Death or a second heart attack occurred in 5.6 percent of the
aspiration group and 9.9 percent of those given conventional
treatment, the researchers reported.
"The point that thrombus aspiration has a role is definitely
made," said study lead author Dr. Felix Zijlstra, head of the
department of acute cardiology at the University Medical Centre
Groningen.
"Nevertheless, we will continue to follow these patients for
many years and define the predictors of long-term, five-year
outcome," he added.
The findings are in the June 7 issue of
The Lancet.
All 1,071 people in the trial were given emergency treatment
called percutaneous coronary intervention (PCI) for the kind of
heart attack formally called ST-elevation myocardial infarction, a
term that refers to the pattern traced out by an electrocardiogram.
The usual treatment is insertion of a balloon-tipped catheter to
reopen the blocked coronary artery. In this trial, a device was
also used to suck out clot particles before insertion of the
catheter.
Use of the technique is starting to spread, Zijlstra said.
"Several companies report, in personal communications, increasing
sales of aspiration devices," he said.
The technique is not difficult to master, Zijlstra said.
"Experienced interventional cardiologists can easily implement
thrombus aspiration in the PCI procedure," he said. "It is not more
demanding than other intracoronary manipulations."
Use of the aspiration technique is being expanded to other
cardiac emergencies, Zijlstra said.
"We are currently enrolling patients in a trial that studies the
role of aspiration in patients with non-ST elevation acute coronary
syndromes," he said. "Results of a pilot study have been accepted
for publication but are not yet publicly available."
Dr. Howard Cohen, director of cardiac intervention at Lenox Hill
Hospital in New York City, said the new study shows that "removing
thrombus [blood clots] markedly improves short- and long-term
outcomes." He added, "I use it all the time."
Some earlier studies showed conflicting results, Cohen said, but
the new report clarifies the situation. "Based on this information,
I think this will change the guidelines in terms of treatment of
thrombus in acute myocardial infarction," he said.
Removing blood clot fragments from the heart blood vessel is
important because "thrombus in an artery is a marker for poor
outcome," Cohen said. "The nice thing about this technique is that
it is very simple and widely applicable, and outcomes are
significantly improved," he said.
Dr. Manesh R. Patel, an assistant professor of medicine in the
division of cardiology at Duke University Medical Center, called
the new findings "promising."
"I would expect a higher use of aspiration, but whether it will
be in all patients, I'm not sure," he said.
At present, Duke cardiologists use aspiration in heart attack
treatment when there is a completely blocked artery and "a large
thrombus burden that is visible," Patel said. The newly reported
results probably will expand the technique's use, he said.
More information
Learn more about treatment of heart attacks from the
American Heart Association.
