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Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST

Umesh U Tamhane1, Stanley Chetcuti, Irfan Hameed

  • 1Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.

BMC Cardiovascular Disorders
|March 2, 2010
PubMed

Insights

Thrombectomy devices improve myocardial perfusion markers in STEMI patients without increasing mortality, but raise stroke risk. Manual aspiration thrombectomy shows a survival benefit trend over mechanical devices.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Conflicting results exist from clinical trials comparing thrombectomy devices with conventional percutaneous coronary interventions (PCI) for acute ST-elevation myocardial infarction (STEMI).
  • A systematic evaluation of available data is needed to clarify the comparative effectiveness of thrombectomy followed by PCI versus PCI alone in STEMI patients.

Purpose of the Study:

  • To systematically evaluate and compare the efficacy and safety of thrombectomy devices plus PCI versus conventional PCI alone in patients with acute STEMI.
  • To assess the impact of thrombectomy on mortality, stroke, myocardial perfusion, and ST-segment resolution.

Main Methods:

  • A meta-analysis of seventeen randomized trials involving 3,909 patients with acute STEMI.
  • Calculation of summary odds ratios for key outcomes including 30-day mortality, stroke, myocardial blush grade (MBG), Thrombolysis in Myocardial Infarction (TIMI) flow grade, and ST-segment resolution (STR).
  • Utilized random-effects and fixed-effects models for data analysis.

Main Results:

  • No significant difference in 30-day mortality between thrombectomy and conventional PCI groups.
  • Thrombectomy significantly improved TIMI 3 flow, MBG 3, and STR.
  • A higher risk of stroke was observed in the thrombectomy group (OR 2.88, P=0.04).
  • Manual aspiration thrombectomy (MAT) showed a trend towards lower mortality (OR 0.59, P=0.05), while mechanical devices trended towards higher mortality (OR 2.07, P=0.07).

Conclusions:

  • Thrombectomy devices enhance myocardial perfusion markers in STEMI patients undergoing primary PCI.
  • While overall 30-day mortality remains unchanged, thrombectomy is associated with an increased risk of stroke.
  • The type of thrombectomy device influences clinical outcomes, with MAT showing a potential survival benefit and mechanical devices a trend towards worse outcomes.
Abstract

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