Original Title: Aspiration thrombectomy prior to percutaneous coronary intervention in ST elevation myocardial infarction: a systematic review and meta-analysis.
Reference: Regina El Dib et al. BMC Cardiovascular Disorders (2016) 16:121.
Courtesy of Dr. Brian Nazareth Donato.
Based on contradicting results obtained from different studies on the role of mechanical aspiration thrombectomy before PCI vs. PCI alone, this new meta-analysis seeks to determine the efficacy of routine use of this technique prior PCI.
MeSH, MEDLINE, EMBASE, and CENTRAL were searched for relevant studies comparing aspiration thrombectomy during PCI vs. PCI alone.
20 studies were included (ADMIT, Belum, Chao, De Luca, Expira, Export, Impact, INFUSE-AMI, ITTI, kaltoft, Liistro, REMEDIA, Shehata, Sim, TAPAS, TASTE, TOTAL, TROFI, VAMPIRE, Yim) with a total 20,866 patients and follow up periods varied between 30 and 365 days.
These studies randomized patients with ST elevation myocardial infarction to PCI + aspiration thrombectomy vs. PCI alone.
Global mortality rate:
- PCI alone: 4.4%
- Aspiration thrombectomy + PCI: 3.9%
(RR 0.89)
Recurrent MI rate:
- PCI alone: 2.4%
- Aspiration thrombectomy + PCI: 2.2%
(RR 094)
Stroke:
- PCI alone: 0.5%
- Aspiration thrombectomy + PCI: 0.8%
(RR 1.56)
Major bleeding:
- PCI alone: 1.7%
- Aspiration thrombectomy + PCI: 1.7%
(RR 1.02)
Conclusion
Evidence suggests the use of aspiration thrombectomy during primary PCI is associated to a small decrease in mortality (4/1000 patients) closely balanced by a small increase in stroke incidence (3/1000 patients). Therefore, because results are exiguous, aspiration thrombectomy should not be used as a routine strategy.
Editorial Comment
In 2015 AHA/ACC guidelines, evidence for the use of aspiration thrombectomy in the context of primary PCI is classified as IIb/C when there are intraluminal thrombi and class III when used as routine strategy for all cases.
The present meta-analyzis included randomized studies with different simple sizes, from 56 to more than 10 thousand patients, and therefore showed no net benefit in support of the systematic use of aspiration thrombectomy during primary PCI. Absolute effects are too small, 4 less deaths over 1000 patients and 3 more strokes over 1000 patients vs. PCI alone.
One of the most important limitations to these studies is the lack of a blind control group due to the nature of this intervention.
Even though today the available literature does not support routine aspiration thrombectomy to manage ST elevation myocardial infarction, there may be individual cases in which an operator may feel the potential benefit of this procedure outweighs its potential risks.
Courtesy of Dr. Brian Nazareth Donato. Hospital Britanico de Buenos Aires, Argentina.
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