Routine manual thrombus aspiration during percutaneous coronary intervention for STEMI did not significantly reduce all-cause mortality compared to PCI alone (RR 0.91, 95% CI 0.80-1.02, P=0.11).
Meta-Analysis (n=21,708)
Does manual thrombus aspiration added to PCI improve clinical outcomes and mortality in patients with STEMI?
Routine manual thrombus aspiration during PCI for STEMI improves angiographic reperfusion markers but does not reduce mortality and is associated with an increased risk of stroke.
Relative Risk: 0.91 (95% CI 0.8–1.02)
p-value: p=0.11
BACKGROUND: The clinical efficacy and safety of adjunctive thrombus aspiration (TA) in patients with ST-segment elevation myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) remain controversial. METHODS: Twenty five eligible randomized controlled trials were included to compare the use of thrombus aspiration (TA) with PCI and PCI-only for STEMI. The primary endpoint was all-cause mortality and death. The secondary endpoints were major adverse cardiac events (MACE), recurrent infarction (RI), target vessel revascularization (TVR), stent thrombosis (ST), perfusion surrogate markers and stroke. RESULTS: TIMI flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI arm compared with the PCI-only arm relative risk (RR): 1.05, 95% confidence intervals (CI): 1.02-1.09, P = 0.004 and (RR: 1.68, 95% CI: 1.40-2.00, P < 0.001), respectively. There were no significant differences in all-cause mortality, MACEs, TVR and ST rates between the two groups. The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm with short-term follow-up duration (RR: 0.60, 95% CI: 0.38-0.96, P = 0.03), but there was no significant difference in RI incidence over the medium- or long-term follow-up periods (RR: 1.00, 95% CI: 0.77-1.29, P = 0.98), and (RR: 0.96, 95% CI: 0.81-1.15, P = 0.69), respectively. There were statistically significant differences in the rates of crude stroke and stroke over the medium- or long-term follow-up periods and the crude stroke rate in the TA plus PCI (RR: 1.60, 95% CI: 1.08-2.38, P = 0.02) and (RR: 1.43, 95% CI: 1.03-1.98, P = 0.03), respectively; this was not observed between the two arms during the short-term follow-up period (RR: 1.47, 95% CI: 0.97-2.21, P = 0.07). CONCLUSIONS: Routine TA-assisted PCI in STEMI patients can improve myocardial reperfusion and get limited benefits related to the clinical endpoints, which may be associated with stroke risk.
Zhang et al. (Sun,) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=21,708). Manual thrombus aspiration plus PCI vs. PCI alone was evaluated on All-cause mortality (RR 0.91, 95% CI 0.80-1.02, p=0.11). Routine manual thrombus aspiration during percutaneous coronary intervention for STEMI did not significantly reduce all-cause mortality compared to PCI alone (RR 0.91, 95% CI 0.80-1.02, P=0.11).