Key result
Routine aspiration thrombectomy prior to primary PCI in STEMI did not significantly reduce all-cause mortality (RR 0.89; 95% CI 0.78-1.01; P=0.08) but increased stroke risk (RR 1.51; P=0.04).
Why the study?
Does routine aspiration thrombectomy prior to PPCI reduce mortality or MACE in patients with STEMI?
Meta-Analysis (n=21,281)
Does routine aspiration thrombectomy prior to PPCI reduce mortality or MACE in patients with STEMI?
Effect estimate: RR 0.89 (95% CI 0.78-1.01)
p-value: p=0.08
Routine aspiration thrombectomy prior to primary PCI in STEMI does not improve clinical outcomes and increases the risk of stroke.
BACKGROUND: The Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in patients with STEMI (TOTAL trial) refuted the salutary effect of routine aspiration thrombectomy (AT) in PPCI for patients with ST-elevation myocardial infarction (STEMI). OBJECTIVES: We performed an updated meta-analysis to assess clinical outcomes with AT prior to PPCI compared with conventional PPCI alone including the additional trial data. METHODS AND RESULTS: Clinical trials (n = 20) that randomized patients (n = 21,281) with STEMI between Routine AT (n = 10,619) and PPCI (n = 10,662) were pooled. There was no difference in all-cause mortality between the 2 groups (RR: 0.89, 95%CI: 0.78-1.01, P = 0.08). Stratifying by follow up at 1-month (RR: 0.87, 95%CI: 0.69-1.10, P = 0.25), up to 6 months (RR: 0.91, 95%CI: 0.74-1.13, P = 0.39 and beyond 6 months (RR: 0.88, 95%CI: 0.74-1.05, P = 0.16) yielded similar results. There was a statistically significant increase risk of stoke rate in the AT arm (RR: 1.51, 95%CI: 1.01-2.25, P = 0.04). The 2 groups were similar with regards to target vessel revascularization (0.94, 95%CI: 0.83-1.06, P = 0.28) recurrent MI (RR: 0.96, 95%CI: 0.80-1.16, P = 0.68, MACE events (RR: 0.91 95%CI: 0.81-1.02, P = 0.11), early (0.59, 95%CI: 0.23-1.50, P = 0.27) and late (RR: 0.91, 95%CI: 0.69-1.18, P = 0.47) stent thrombosis and net clinical benefit (RR 0.99, 95%CI: 0.91-1.07, P = 0.76). CONCLUSION: Routine AT prior to PPCI in STEMI is associated with higher risk of stroke. There is no statistical difference in clinical outcome parameters of mortality, major adverse cardiac events, target vessel revascularization, stent thrombosis, and net clinical benefit between AT and PCI alone.
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Ghatak et al. (2015) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) (n=21,281). Routine aspiration thrombectomy (AT) vs. Conventional PPCI alone was evaluated on All-cause mortality (RR 0.89, 95% CI 0.78-1.01, p=0.08). Routine aspiration thrombectomy prior to primary PCI in STEMI did not significantly reduce all-cause mortality (RR 0.89; 95% CI 0.78-1.01; P=0.08) but increased stroke risk (RR 1.51; P=0.04).
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