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Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy

Sanjit S Jolly1, Stefan James2, Vladimír Džavík2

  • 1From McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada (S.S.J., S.Y., P.G., A.A., B.M.); Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Uppsala, Sweden (S.J., H.R., B.L.); Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (V.D.); University of British Columbia, Vancouver, BC, Canada (J.A.C.); Department of Cardiology, Thorax Center, Erasmus Medical Centre, Rotterdam, the Netherlands (K.D.M., F.Z.); Skåne University Hospital-Lund/Lund University, Lund, Sweden (G.K.O.); University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, Macedonia (S.K.); Clinical Center of Serbia and Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia (G.S.); and Örebro University, Faculty of Health, Department of Cardiology, Södra Grev Rosengatan, Örebro, Sweden (O.F.). sanjit.jolly@phri.ca.

Circulation
|December 13, 2016
PubMed

Insights

Routine thrombus aspiration during percutaneous coronary intervention for ST-elevation myocardial infarction did not improve outcomes. In patients with high thrombus burden, aspiration showed trends toward reduced cardiovascular death but increased stroke risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Thrombus aspiration is commonly used in percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
  • Recent trials have raised questions about its efficacy and safety.
  • This meta-analysis pooled individual patient data from major trials to re-evaluate its benefits and risks.

Purpose of the Study:

  • To determine the benefits and risks of thrombus aspiration during PCI in STEMI patients.
  • To analyze cardiovascular mortality and stroke/transient ischemic attack rates.
  • To investigate outcomes in subgroups, particularly those with high thrombus burden.

Main Methods:

  • Individual patient data meta-analysis of 3 large randomized controlled trials (TAPAS, TASTE, TOTAL).
  • Included patients (n=18,306) undergoing PCI for STEMI.
  • Primary outcomes: 30-day cardiovascular mortality and 30-day stroke/transient ischemic attack.

Main Results:

  • No significant difference in 30-day cardiovascular death (2.4% vs 2.9%, P=0.06) or stroke/TIA (0.8% vs 0.5%, P=0.06) between thrombus aspiration and PCI alone.
  • In the high thrombus burden subgroup, aspiration was linked to fewer deaths (P=0.03) but more strokes (P=0.04).
  • No significant differences observed for recurrent MI, stent thrombosis, heart failure, or TVR.

Conclusions:

  • Routine thrombus aspiration in STEMI PCI does not improve overall clinical outcomes.
  • High thrombus burden patients showed trends suggesting potential benefit in mortality but increased stroke risk, warranting further investigation.
  • Future trials could explore improved aspiration technologies for specific high-risk subgroups.
Abstract

Keywords:
meta-analysis [publication type]myocardial infarctionthrombectomy

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