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Thrombus aspiration in patients with ST elevation myocardial infarction: meta-analysis of 16 randomized trials
İbrahim Halil Tanboğa1, Selim Topçu, Enbiya Aksakal
1Department of Cardiology, Faculty of Medicine, Atatürk University; Erzurum-Turkey. haliltanboga@yahoo.com.
Insights
Thrombus aspiration during primary percutaneous coronary intervention did not reduce mortality or major adverse cardiac events. While improving perfusion, it did not significantly impact clinical outcomes like death, re-infarction, or stroke.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- High mortality in primary percutaneous coronary intervention (PPCI) is linked to poor perfusion.
- Thrombus aspiration (TA) is a potential adjunct to PPCI, but evidence on its efficacy is conflicting.
Purpose of the Study:
- To compare the efficacy and safety of PPCI with thrombus aspiration (PPCI+TA) versus PPCI alone.
- To evaluate the impact of TA on epicardial and myocardial perfusion and clinical outcomes.
Main Methods:
- A meta-analysis was conducted following PRISMA guidelines.
- Included 16 studies with 5262 patients in PPCI and 5256 patients in PPCI+TA groups.
- Assessed outcomes including TIMI flow, myocardial blush grade, stent thrombosis resolution, all-cause death, re-infarction, TVR/TLR, stent thrombosis, and stroke.
Main Results:
- PPCI+TA showed significantly higher postprocedural TIMI-III flow, myocardial blush grade, and stent thrombosis resolution.
- No significant differences were observed in all-cause mortality, recurrent myocardial infarction, TVR/TLR, stent thrombosis, or stroke rates between the groups.
Conclusions:
- Thrombus aspiration in STEMI patients undergoing PPCI does not reduce rates of all-cause mortality, re-infarction, TVR/TLR, stent thrombosis, or stroke.
- This updated meta-analysis provides evidence against routine use of TA in this patient population.
Objective:
The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone.
Methods:
Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke.
Results:
Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups.
Conclusion:
This meta-analysis is the first updated analysis after publishing the 1-year result of the "Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction" trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke.
