Efficacy and safety of routine thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: An updated systematic review and meta-analysis of randomized controlled trials

Ioannis Mastoris, Gennaro Giustino, Samantha Sartori, Usman Baber, Roxana Mehran, Annapoorna S. Kini, Samin K. Sharma, George D. Dangas

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background Randomized clinical trials evaluating the role of thrombus aspiration (TA) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) have yielded contrasting results. Therefore, the efficacy and safety of TA in STEMI is unclear. Objective We sought to evaluate the efficacy and safety of TA during PPCI for STEMI compared with conventional PPCI alone. Methods We included study-level data from 25 randomized, controlled trials, involving 21,733 patients with STEMI and PPCI. The primary efficacy endpoint was major adverse cardiac events (MACE) according to study definitions; the primary safety endpoint was stroke. Results The mean weighted follow-up time across studies was 8.2 months. Compared with conventional PPCI, TA was associated with significant lower risk for MACE [relative risk (RR): 0.91; 95% confidence interval (CI): 0.83-1.00; P = 0.042). However, this benefit in MACE was counterbalanced by a significant increase in the risk for stroke (RR: 1.58; 95% CI: 1.11-2.25; P = 0.011). There were no differences in the risk of myocardial infarction (RR: 0.94; 95% CI: 0.78-1.12; P = 0.486), target vessel revascularization (RR: 0.93; 95% CI: 0.82-1.04; P = 0.2), and definite or probable stent thrombosis (RR: 0.84; 95% CI: 0.66-1.07; P = 0.148). TA was associated with an ostensible lower risk for all-cause mortality, which did not reach statistical significance (RR: 0.88; 95% CI: 0.78-1.00; P = 0.059). Conclusions Compared with conventional PPCI for STEMI, adjunctive TA reduces the risk of subsequent MACE. However, the benefit in MACE is counterbalanced by an increased risk in stroke. Considering the above potential risks and benefits, TA should be considered in selected patients lesions rather than routinely.

Original languageEnglish
Pages (from-to)650-660
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume87
Issue number4
DOIs
StatePublished - 1 Mar 2016

Keywords

  • STEMI
  • percutaneous coronary intervention
  • thrombus aspiration

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