Related Experiment Video
Updated: Nov 8, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Aspiration thrombectomy in ST-Elevation myocardial infarction: Further insights from a network meta-analysis of
Rama Dilip Gajulapalli1, Arun Kanmanthareddy2, Kathir Balakumaran3
1Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
Insights
Aspiration thrombectomy (AT) in ST-elevation myocardial infarction (STEMI) patients may reduce mortality, major adverse cardiac events, and myocardial infarction compared to conventional PCI. However, outcomes regarding stroke and stent thrombosis require further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Thrombectomy during percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) has seen shifting clinical perspectives.
- Limited evidence suggests potential benefits in specific patient subgroups.
Purpose of the Study:
- To conduct a network meta-analysis comparing conventional PCI (cPCI), Aspiration thrombectomy (AT), and Mechanical thrombectomy (McT).
- To clarify the efficacy and safety of different thrombectomy strategies in STEMI patients.
Main Methods:
- A systematic search of randomized controlled trials comparing AT, McT, or cPCI.
- Network meta-analysis to generate odds ratios (OR) and 95% confidence intervals for various clinical outcomes.
- Evaluation of major adverse cardiac events (MACE), mortality, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stroke, left ventricular ejection fraction (LVEF), myocardial blush grade (MBG), and ST segment resolution (STR).
Main Results:
- Analysis of 43 randomized trials with 26,682 participants.
- AT was associated with lower risks of MACE (OR 0.86), mortality (OR 0.85), MI (OR 0.65), and TVR (OR 0.86) compared to cPCI.
- No significant difference in ST or stroke risk with AT; improvements observed in MBG, STR, and LVEF.
Conclusions:
- Network meta-analysis indicates mixed outcomes with AT in STEMI patients.
- While AT shows promise in reducing mortality, MACE, and MI, potential increases in stroke and ST risk warrant caution.
- Further research is needed to determine the role of AT in select STEMI cases.
Background:
The initial enthusiasm for thrombectomy during percutaneous coronary intervention (PCI) of ST-elevation myocardial infarction (STEMI) patients has given way to restraint. There has been some limited interest whether it is beneficial in a few selected subgroups. Hence, we performed a network meta-analysis to compare conventional PCI (cPCI), Aspiration or manual thrombectomy (AT) and Mechanical thrombectomy (McT) for clarification.
Methods:
Electronic databases were searched for randomized studies that compared AT, McT, or cPCI. A network meta-analysis was performed and odd's ratio (OR) with 95% confidence intervals was generated for major adverse cardiac events (MACE), mortality, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stroke, left ventricular ejection fraction (LVEF), myocardial blush grade (MBG) and ST segment resolution (STR).
Results:
A total of 43 randomized trials (n = 26,682) were included. The risk of MACE (OR 0.86 95% CI 0.73-1.00), Mortality (OR 0.85 95% CI 0.73-0.99), MI (OR 0.65, 95% CI: 0.44-0.95) and TVR (OR 0.86, 95% CI: 0.74-1.00) were lower with AT compared to cPCI. The risk of ST and stroke was no different with the use of adjunctive AT. MBG, STR, and LVEF improved with the use of AT while the infarct size was no different in the two groups.
Conclusions:
Our comprehensive network meta-analysis suggests conflicting outcomes with AT. While Mortality, MACE, MI seem better, there is a suggestion that, Stroke and ST might be worse. Whether AT can still be pursued in any select cases should be further scrutinized.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies