What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: ST-segment elevation myocardial infarction (STEMI) (n=11780). Intervention: Manual thrombus aspiration vs. Conventional percutaneous coronary intervention (PCI). Primary outcome: All-cause mortality at long-term follow-up (≥ 1 year) (RR 0.86, 95% CI 0.73 to 1.02, p=0.09).

November 18, 2014Open Access

Adjunctive Manual Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

Q: What does this research mean for the field?

Manual thrombus aspiration does not significantly reduce long-term all-cause mortality compared to conventional PCI in patients with STEMI. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

SDSongbai DengDalian Medical University JWJing WangYangzhou Vocational University JXJun XiaoChongqing Emergency Medical Center

Key Result

Manual thrombus aspiration did not significantly reduce long-term all-cause mortality compared to conventional PCI in patients with STEMI.

Study Design

Type

Meta-Analysis (n=11,780)

Multicenter

Yes

Structured PICO

Does manual thrombus aspiration improve clinical outcomes in patients with STEMI compared to conventional PCI?

Population

11,780 patients with ST-segment elevation myocardial infarction (STEMI) pooled from 26 RCTs

Intervention

Manual thrombus aspiration

Comparator

Conventional percutaneous coronary intervention (PCI)

Outcome

Clinical outcomes including mortality, reinfarction, target vessel revascularization, and composite major adverse cardiac events (MACEs) at different follow-up periods (hospital to 30 days, 12 to 24 months, long-term)hard clinical

Adjunctive manual thrombus aspiration during STEMI does not provide distinct long-term clinical benefits in mortality, reinfarction, or target vessel revascularization compared to conventional PCI.

Main Result

Effect estimate: RR 0.86 (95% CI 0.73 to 1.02)

Absolute Event Rate: 5.04% vs 5.83%

p-value: p=0.09

Limitations

Meta-analysis was not performed on individual patient data because complete data sets were not available.
Only the TASTE trial was powered for mortality and the other clinical events reported, while the other included trials' sample sizes were small.
The number of screened subjects or percentages of included vs. candidate subjects in a number of included studies were not accounted for.

Abstract

OBJECTIVE: The aim of this study was to synthesize evidence by examining the effects of manual thrombus aspiration on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 26 randomized controlled trials (RCTs), enrolling 11,780 patients, with 5,869 patients randomized to manual thrombus aspiration and 5,911 patients randomized to conventional percutaneous coronary intervention (PCI), were included in the meta-analysis. Separate clinical outcome analyses were based on different follow-up periods. There were no statistically reductions in the incidences of mortality (risk ratio RR, 0.86 95% confidence interval [CI: 0.73 to 1.02]), reinfarction (RR, 0.62 CI, 0.31 to 1.32) or target vessel revascularization (RR, 0.89 CI, 0.75 to 1.05) in the manual thrombus aspiration arm at 12 to 24 months of follow-up. The composite major adverse cardiac events (MACEs) outcomes were significantly lower in the manual thrombus aspiration arm over the long-term follow-up (RR, 0.76 CI, 0.63 to 0.91). A lower incidence of reinfarction was observed in the hospital to 30 days (RR, 0.59 CI, 0.37 to 0.92). CONCLUSION: The present meta-analysis suggested that there was no evidence that using manual thrombus aspiration in patients with STEMI could provide distinct benefits in long-term clinical outcomes.

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