Response to Letter Regarding Article, “Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention? Meta-Analysis of Randomized Trials”

HomeCirculation: Cardiovascular InterventionsVol. 8, No. 10Response to Letter Regarding Article, "Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention? Meta-Analysis of Randomized Trials" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, "Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention? Meta-Analysis of Randomized Trials" Islam Y. Elgendy, MD and Tianyao Huo, MS Deepak L. Bhatt, MD, MPH Anthony A. Bavry, MD, MPH Islam Y. ElgendyIslam Y. Elgendy Department of Medicine, University of Florida, Gainesville, FL and Tianyao HuoTianyao Huo Department of Medicine, University of Florida, Gainesville, FL Deepak L. BhattDeepak L. Bhatt Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA Anthony A. BavryAnthony A. Bavry Department of Medicine, University of Florida, Gainesville, FLMedicine Service, North Florida/South Georgia Veterans Health System, Gainesville, FL Originally published28 Sep 2015https://doi.org/10.1161/CIRCINTERVENTIONS.115.003154Circulation: Cardiovascular Interventions. 2015;8:e003154We appreciate the comments of Dr Nuñez-Gil et al1 about our meta-analysis.2 We agree that aspiration thrombectomy might be beneficial in certain cases; however, the routine use of this therapy can no longer be recommended. The second comment was about the discordance between clinical practice and published trials. Although this is an accurate statement, the lack of survival benefit observed with aspiration thrombectomy has been documented in large registries.3,4 Finally, this study was not the first to document a potential increase in the risk of stroke with aspiration thrombectomy. An earlier meta-analysis cautioned on this hazard.5 In the largest trial evaluating outcomes with aspiration thrombectomy (ie, A Trial of Routine Aspiration Thrombectomy With Percutaneous Coronary Intervention [PCI] Versus PCI Alone in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI [TOTAL]), the risk of stroke was increased with aspiration thrombectomy, especially within the first 48 hours.6 The concept of aspiration thrombectomy still seems valid; however, future trials will need to test more effective thrombectomy devices and use of thrombectomy in higher risk patients (ie, those with large thrombus).Islam Y. Elgendy, MDTianyao Huo, MSDepartment of MedicineUniversity of FloridaGainesville, FLDeepak L. Bhatt, MD, MPHBrigham and Women's Hospital Heart and Vascular CenterHarvard Medical SchoolBoston, MAAnthony A. Bavry, MD, MPHDepartment of MedicineUniversity of FloridaGainesville, FLMedicine ServiceNorth Florida/South Georgia Veterans Health SystemGainesville, FLDisclosuresDr Bhatt discloses the following relationships—Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Get With The Guidelines Steering Committee; Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute (including for the TOTAL trial); Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor); Research Funding: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, St. Jude Medical, The Medicines Company; Trustee: American College of Cardiology; Unfunded Research: FlowCo, PLx Pharma, Takeda. Dr Bavry discloses the following relationship—Honorarium from American College of Cardiology. The other authors report no conflicts.References1. Nuñez-Gil IJ, Salinas P, Nogueira RH.Letter by Nuñez-Gil et al regarding article, "Is aspiration thrombectomy beneficial in patients undergoing primary percutaneous coronary intervention? Meta-analysis of randomized trials." Circ Cardiovasc Interv. 2015; 8:e003137. doi: 10.1161/CIRCINTERVENTIONS.115.003137.LinkGoogle Scholar2. Elgendy IY, Huo T, Bhatt DL, Bavry AA.Is aspiration thrombectomy beneficial in patients undergoing primary percutaneous coronary intervention? Meta-analysis of randomized trials.Circ Cardiovasc Interv. 2015; 8:e002258. doi: 10.1161/CIRCINTERVENTIONS.114.002258.LinkGoogle Scholar3. Jones DA, Rathod KS, Gallagher S, Jain AK, Kalra SS, Lim P, Crake T, Ozkor M, Rakhit R, Knight CJ, Iqbal MB, Dalby MC, Malik IS, Whitbread M, Mathur A, Redwood S, MacCarthy PA, Weerackody R, Wragg A.Manual thrombus aspiration is not associated with reduced mortality in patients treated with primary percutaneous coronary intervention: an observational study of 10,929 patients with ST-segment elevation myocardial infarction from the London Heart Attack Group.JACC Cardiovasc Interv. 2015; 8:575–584. doi: 10.1016/j.jcin.2014.11.021.MedlineGoogle Scholar4. Fröbert O, Lagerqvist B, Kreutzer M, Olivecrona GK, James SK.Thrombus aspiration in ST-elevation myocardial infarction in Sweden: a short report on real world outcome.Int J Cardiol. 2010; 145:572–573. doi: 10.1016/j.ijcard.2010.05.044.CrossrefMedlineGoogle Scholar5. Bavry AA, Kumbhani DJ, Bhatt DL.Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials.Eur Heart J. 2008; 29:2989–3001. doi: 10.1093/eurheartj/ehn421.CrossrefMedlineGoogle Scholar6. Jolly SS, Cairns JA, Yusuf S, Meeks B, Gao P, Hart RG, Kedev S, Stankovic G, Moreno R, Horak D, Kassam S, Rokoss MJ, Leung RC, El-Omar M, Romppanen HO, Alazzoni A, Alak A, Fung A, Alexopoulos D, Schwalm JD, Valettas N, Džavík V.Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction [published online ahead of print June 30, 2015]. Eur Heart J. 2015. doi: 10.1093/eurheartj/ehv296.CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails October 2015Vol 8, Issue 10 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.115.003154PMID: 26415602 Originally publishedSeptember 28, 2015 PDF download Advertisement SubjectsTreatment