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Aspiration thrombectomy prior to percutaneous coronary intervention in ST-elevation myocardial infarction: a

Regina El Dib1,2, Frederick Alan Spencer3, Erica Aranha Suzumura4

  • 1Department of Anaesthesiology, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Brazil.

BMC Cardiovascular Disorders
|June 4, 2016
PubMed

Insights

Aspiration thrombectomy (AT) before primary percutaneous intervention (PCI) for ST-segment elevation MI (STEMI) may slightly reduce mortality but increases stroke risk. Due to minimal absolute differences, AT is not recommended as a routine strategy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Technology

Background:

  • Aspiration thrombectomy (AT) prior to primary percutaneous intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has yielded inconsistent trial results.
  • Uncertainty exists regarding the net clinical benefit of AT in STEMI patients.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of aspiration thrombectomy prior to primary PCI compared to conventional PCI in STEMI patients.
  • To synthesize evidence from randomized controlled trials (RCTs) to inform clinical practice guidelines.

Main Methods:

  • Comprehensive literature search of MEDLINE, EMBASE, and CENTRAL databases up to June 2015.
  • Inclusion of 20 RCTs involving 21,660 patients undergoing PCI for STEMI.
  • Data extraction and risk of bias assessment by independent reviewers, utilizing the GRADE approach for evidence certainty.

Main Results:

  • Moderate-certainty evidence indicated a non-significant trend towards reduced overall mortality with AT (RR 0.89).
  • No significant difference was observed in recurrent myocardial infarction (MI) or major bleeding events.
  • A statistically significant increase in stroke incidence was noted (RR 1.56), representing 3 additional strokes per 1000 patients over 6 months.

Conclusions:

  • Aspiration thrombectomy may offer a small, uncertain reduction in mortality but carries a risk of increased stroke.
  • The absolute benefits and harms are small and closely balanced, making AT not advisable as a routine strategy.
  • Further research may be needed to identify specific patient subgroups who could benefit from AT.
Abstract

Keywords:
Aspiration thrombectomyGRADEMeta-analysisMyocardial infarctionSystematic review

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