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Published on: January 18, 2018
Meta-Analysis of the Long-Term Effect of Routine Aspiration Thrombectomy in Patients Undergoing Primary Percutaneous
Joseph G Mancini1, Kristian B Filion2, Sarah B Windle1
1Division of Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital/McGill University, Montreal, Québec, Canada.
Insights
Routine aspiration thrombectomy during primary percutaneous coronary intervention (PCI) offers short-term reperfusion benefits but does not improve long-term outcomes and increases stroke risk, according to a meta-analysis of randomized controlled trials.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Current guidelines de-emphasize routine aspiration thrombectomy in primary percutaneous coronary intervention (PCI).
- Recent randomized controlled trials (RCTs) suggest prior overestimation of long-term benefits.
- Evidence review is needed to clarify its role.
Purpose of the Study:
- To systematically review and meta-analyze RCTs.
- To assess the effect of aspiration thrombectomy versus PCI alone on reperfusion markers and clinical outcomes (≥6 months).
Main Methods:
- Systematic search of Medline, EMBASE, and Cochrane Library for RCTs (English/French, follow-up ≥6 months).
- Data pooling using random-effects models.
- Inclusion of 14 RCTs with 20,285 participants.
Main Results:
- Aspiration thrombectomy improved immediate reperfusion markers: ST-segment resolution (RR 1.22), myocardial blush grade 3 (RR 1.30), and reduced no-reflow risk (RR 0.63).
- No significant difference in all-cause mortality (RR 0.92), myocardial infarction, or revascularization at ≥6 months.
- Increased risk of stroke (RR 1.59) was observed.
Conclusions:
- Routine aspiration thrombectomy in primary PCI shows short-term reperfusion advantages.
- It does not enhance clinical outcomes at ≥6 months follow-up.
- Routine use is associated with an increased risk of stroke.
Abstract:
American College of Cardiology Foundation/American Heart Association guidelines no longer recommend the use of routine aspiration thrombectomy during primary percutaneous coronary intervention (PCI). This is based on evidence from recent randomized controlled trials (RCTs) that suggests that the long-term benefits of aspiration thrombectomy were previously overestimated. We conducted a systematic review and meta-analysis of RCTs to examine the effect of routine aspiration thrombectomy during primary PCI versus primary PCI alone on markers of reperfusion immediately after PCI and on clinical outcomes at ≥6 months. We systematically searched Medline, EMBASE, and the Cochrane Library of Clinical trials for RCTs published in English or French with follow-up ≥6 months. Data were pooled using random-effects models. Eighteen publications (containing data from 14 RCTs, n = 20,285) met our inclusion criteria. Aspiration thrombectomy was associated with higher rates of ST-segment resolution (relative risk [RR] 1.22, 95% CI 1.07 to 1.40) and myocardial blush grade 3 (RR 1.30, 95% CI 1.01 to 1.67) and a reduced risk of no reflow immediately after PCI (RR 0.63, 95% CI 0.40 to 0.98). However, thrombectomy was not associated with our primary outcome of all-cause mortality at longest available follow-up (RR 0.92, 95% CI 0.81 to 1.04). Similar results were obtained for myocardial infarction and target vessel/lesion revascularization. Thrombectomy also increased the risk of stroke (RR 1.59, 95% CI 1.07 to 2.35). In conclusion, routine aspiration thrombectomy during primary PCI has some short-term clinical benefits but does not improve outcomes ≥6 months and increases the risk of stroke.
