Original Title: Meta-analysis of the long-term effect of routine aspiration thrombectomy in patients undergoing primary percutaneous coronary intervention.

Reference: Mancini JG et al. Am J Cardiol. 2016; Epub ahead of print.

A large meta-analyzis confirms routine aspiration thrombectomy in the context of primary PCI has no clinical benefit and could increase the risk of stroke.

These findings coincide with the TOTAL trial findings published last year. This evidence justified updating the ACC and AHA guidelines and aspiration thrombectomy became class III.

Nonetheless, the truth is many interventional cardiologists continue to aspirate thrombi, only more selectively, choosing to do it on patients with heavier thrombotic load.

This meta-analyzis included 18 contemporary studies comparing routine aspiration thrombectomy vs primary PCI alone in more than 20000 patients undergoing ST elevation AMI with at least 6 months follow up.

Despite aspiration thrombectomy was associated with higher ST segment resolution (RR 1.22; CI 95% 1.07-1.40), higher BLUSH 3 rate (RR 1.30; IC 95% 1.01-1.67) and lower post PCI no reflow risk (RR 0.63; CI 95% 0.40-0.98) it did not improve any of the clinical end points, not even mortality. In fact, aspiration thrombectomy seems to increase the risk of stroke.

These findings suggest the clinical effect of routine thrombectomy was overestimated in prior studies and since the publication of the TOTAL and TASTE trials there is no evidence to support this. Today, it is highly unlikely that another large randomized study on routine aspiration thrombectomy will be designed, though it would be interesting to have more data on its selective use (e.g.: patients with evolved infarction or with heavy thrombotic load).