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Adjunctive manual thrombus aspiration during ST-segment elevation myocardial infarction: a meta-analysis of
Song-Bai Deng1, Jing Wang1, Jun Xiao2
1Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Manual thrombus aspiration in ST-segment elevation myocardial infarction (STEMI) did not reduce long-term mortality or reinfarction. However, it significantly lowered major adverse cardiac events over the long term.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion.
- Manual thrombus aspiration is a technique used during percutaneous coronary intervention (PCI) to remove thrombus.
- The clinical benefit of manual thrombus aspiration in STEMI remains debated.
Purpose of the Study:
- To synthesize evidence on the impact of manual thrombus aspiration on clinical outcomes in STEMI patients.
- To evaluate the efficacy of manual thrombus aspiration compared to conventional PCI.
Main Methods:
- A meta-analysis of 26 randomized controlled trials (RCTs) involving 11,780 STEMI patients.
- Comparison of manual thrombus aspiration versus conventional PCI.
- Analysis of clinical outcomes at various follow-up periods (in-hospital to 24 months).
Main Results:
- No significant reduction in long-term mortality, reinfarction, or target vessel revascularization at 12-24 months.
- Significant reduction in composite major adverse cardiac events (MACEs) with manual thrombus aspiration over long-term follow-up.
- Lower incidence of in-hospital to 30-day reinfarction observed with manual thrombus aspiration.
Conclusions:
- Manual thrombus aspiration in STEMI patients does not demonstrate clear long-term benefits for individual clinical outcomes.
- A potential benefit of manual thrombus aspiration may exist for composite MACEs and early reinfarction.
- Further research may be needed to clarify the role of manual thrombus aspiration in STEMI management.
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.
