What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: ST-segment elevation myocardial infarction (STEMI) (n=21708). Intervention: Manual thrombus aspiration plus PCI vs. PCI alone. Primary outcome: All-cause mortality (RR 0.91, 95% CI 0.80-1.02, p=0.11).

May 1, 2016Open Access

Additional manual thrombus aspiration for ST-segment elevation myocardial infarction during percutaneous coronary intervention: an updated meta-analysis.

YZYan ZhangShihezi University LPLi PengXiangyang Central Hospital YFYong‐Yan FanCapital Medical University

Key Result

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).

Study Design

Type

Meta-Analysis (n=21,708)

Structured PICO

Does manual thrombus aspiration added to PCI improve clinical outcomes and mortality in patients with STEMI?

Population

21,708 patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention included in a meta-analysis of 25 randomized controlled trials.

Intervention

Manual thrombus aspiration (TA) in addition to percutaneous coronary intervention (PCI)

Comparator

Percutaneous coronary intervention (PCI) only

Outcome

All-cause mortality and deathhard clinical

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.

Main Result

Relative Risk: 0.91 (95% CI 0.8–1.02)

p-value: p=0.11

Limitations

Publication bias may be unavoidable
Differences between included studies in patient characteristics, study designs, thrombectomy devices, inclusion/exclusion criteria, follow-up periods, and endpoint definitions
Registry-based trials included in the analysis might underestimate non-fatal events, particularly minor strokes

Abstract

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.

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