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Published on: January 18, 2018
Meta-analysis of randomized controlled trials comparing percutaneous coronary intervention with aspiration
Abel Casso Dominguez1, John A Bittl2, Georges El-Hayek1
1Mount Sinai Saint Luke's-Roosevelt Hospital, New York, New York.
Insights
A meta-analysis found that routine aspiration thrombectomy during primary PCI for STEMI did not significantly reduce mortality or major adverse cardiac events. Further research is needed for selected patients with large thrombus burden.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may improve microvascular reperfusion.
- However, its impact on clinical outcomes remains controversial.
Purpose of the Study:
- To evaluate the impact of aspiration thrombectomy (AT) during primary PCI for STEMI on clinical outcomes.
- To synthesize evidence from randomized controlled trials (RCTs) to assess the efficacy of AT.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, EMBASE, Scopus, CENTRAL, ClinicalTrials.gov) up to March 31, 2015.
- Included RCTs compared AT with PCI versus PCI alone in STEMI patients.
- Primary endpoint was all-cause mortality; secondary endpoints included MACE, recurrent MI, TVR, stent thrombosis, and stroke.
Main Results:
- Eighteen RCTs with 21,501 patients were analyzed (10,544 with AT, 10,957 controls).
- AT was not associated with a significant reduction in all-cause mortality (P=0.07), MACE (P=0.06), recurrent MI (P=0.77), TVR (P=0.23), stent thrombosis (P=0.17), or stroke (P=0.19).
Conclusions:
- The routine use of aspiration thrombectomy in STEMI patients undergoing primary PCI did not significantly reduce key clinical outcomes based on evidence up to 2015.
- The role of AT in specific patient subgroups, particularly those with a high thrombus burden, warrants further investigation.
Objectives:
Evaluate the impact of aspiration thrombectomy (AT) during primary coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) on clinical outcomes.
Background:
AT during PCI for STEMI may improve microvascular reperfusion, but its impact on clinical outcomes has remained controversial.
Methods:
We searched Pubmed, EMBASE, Medline, Scopus, CENTRAL, andClinicalTrials.gov databases on March 31, 2015 for randomized controlled trials that evaluated the use of AT with PCI compared with PCI alone for STEMI. The primary end point was all-cause mortality. Secondary end points included major adverse cardiac events (MACE, consisting of death, myocardial infarction, and target-vessel revascularization), recurrent myocardial infarction (MI), target-vessel revascularization (TVR), stent thrombosis and stroke.
Results:
Eighteen randomized controlled trials (n = 21,501) fulfilled the inclusion criteria. A total of 10,544 patients were treated with AT and PCI, compared to 10,957 control patients. The use of AT was not associated with a significant decrease in all-cause mortality (RR 0.88; 95% CI 0.78-1.01; P = 0.07), MACE (RR 0.93; 95% CI 0.86-1.00; P = 0.06), recurrent MI (RR 0.97: 95% CI 0.81-1.17; P = 0.77), TVR (RR 0.93; 95% CI 0.82-1.05; P = 0.23), stent thrombosis (RR 0.84; 95% CI 0.66-1.07; P = 0.17), or stroke (RR 1.35; 95% CI 0.86-2.11; P = 0.19).
Conclusions:
Using the totality of evidence available through 2015, this meta-analysis failed to show that the routine use of aspiration thrombectomy in patients with ST-elevation myocardial infarction significantly reduces all-cause mortality, MACE, recurrent MI, TVR, or stent thrombosis. The role of aspiration thrombectomy in selected patients with angiographic evidence of large thrombus burden requires further clinical investigation. © 2015 Wiley Periodicals, Inc.
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