Key result
Routine aspiration thrombectomy during primary PCI improved MBG scores (OR 0.69; p=0.010) and STR >50% but did not reduce mortality (OR 0.89; p=0.76) at >30 days.
Why the study?
Does routine aspiration thrombectomy improve clinical outcomes in patients with STEMI undergoing primary PCI?
Meta-Analysis (n=20,605)
Does routine aspiration thrombectomy improve clinical outcomes in patients with STEMI undergoing primary PCI?
Odds Ratio: 0.89
p-value: p=0.76
Routine aspiration thrombectomy during primary PCI for STEMI improves surrogate markers of myocardial perfusion but does not improve clinical outcomes such as mortality, reinfarction, or stroke at >30 days.
Routine AT improves perfusion surrogates without reducing mortality or reinfarction; reinforces selective rather than routine use in primary PCI.
BACKGROUND: Recent randomized controlled trials (RCTs) have questioned the clinical efficacy and safety of routine aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI). A systematic synthesis of these randomized data is hence very timely to address this clinical equipoise. METHODS: We performed a meta-analysis of the larger (>150 patients) RCTs that compared AT with only primary PCI. Procedural endpoints were myocardial blush grade (MBG) score of 0 or 1 and ST-segment resolution (STR) >50%. Midterm endpoints were mortality, reinfarction, target vessel revascularization, and stroke >30 days after the procedure. RESULTS: We identified 11 large RCTs, with 10,309 patients randomized to AT and 10,296 to routine strategy (RT). While AT was associated with significantly improved myocardial perfusion, as demonstrated by the MBG score (OR = 0.69; p = 0.010), and improved rates of STR >50% (OR = 1.41; p = 0.006), there were no differences in mortality (OR = 0.89; p = 0.76), reinfarction (OR = 0.9; p = 0.47), target vessel revascularization (TVR; OR = 1.06; p = 0.67), and stroke rates (OR = 1.49; p = 0.29) >30 days after the procedure. CONCLUSION: Our meta-analysis of 20,605 patients who participated in large RCTs demonstrates improved MBG scores and STR >50% with AT compared with only PCI, but no differences were observed in mortality, reinfarction, TVR, and stroke rates at 30 days. Our study supports the latest ACC/AHA/SCAI focused update document that recommends against the routine use of AT during primary PCI.
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Marmagkiolis et al. (2017) conducted a meta-analysis in ST-segment elevation myocardial infarction (n=20,605). Routine aspiration thrombectomy vs. Primary PCI only was evaluated on Mortality >30 days after the procedure (OR 0.89, p=0.76). Routine aspiration thrombectomy during primary PCI improved MBG scores (OR 0.69; p=0.010) and STR >50% but did not reduce mortality (OR 0.89; p=0.76) at >30 days.
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