Meta-Analysis of Randomized Controlled Trials Comparing Percutaneous Coronary Intervention With Aspiration Thrombectomy Vs. Conventional Percutaneous Coronary Intervention During ST-Segment Elevation Myocardial Infarction

Objectives: Evaluate the impact of aspiration thrombectomy (AT) during primary coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) on clinical outcomes. Background: AT during PCI for STEMI may improve microvascular reperfusion, but its impact on clinical outcomes has remained controversial. Methods: We searched Pubmed, EMBASE, Medline, Scopus, CENTRAL, andClinicalTrials.gov databases on March 31, 2015 for randomized controlled trials that evaluated the use of AT with PCI compared with PCI alone for STEMI. The primary end point was all-cause mortality. Secondary end points included major adverse cardiac events (MACE, consisting of death, myocardial infarction, and target-vessel revascularization), recurrent myocardial infarction (MI), target-vessel revascularization (TVR), stent thrombosis and stroke. Results: Eighteen randomized controlled trials (n=21,501) fulfilled the inclusion criteria. A total of 10,544 patients were treated with AT and PCI, compared to 10,957 control patients. The use of AT was not associated with a significant decrease in all-cause mortality (RR 0.88; 95% CI 0.78-1.01; P=0.07), MACE (RR 0.93; 95% CI 0.86-1.00; P=0.06), recurrent MI (RR 0.97: 95% CI 0.81-1.17; P=0.77), TVR (RR 0.93; 95% CI 0.82-1.05; P=0.23), stent thrombosis (RR 0.84; 95% CI 0.66-1.07; P=0.17), or stroke (RR 1.35; 95% CI 0.86-2.11; P=0.19). Conclusions: Using the totality of evidence available through 2015, this meta-analysis failed to show that the routine use of aspiration thrombectomy in patients with ST-elevation myocardial infarction significantly reduces all-cause mortality, MACE, recurrent MI, TVR, or stent thrombosis. The role of aspiration thrombectomy in selected patients with angiographic evidence of large thrombus burden requires further clinical investigation. (C) 2015 Wiley Periodicals, Inc.