A new round against aspiration thrombectomy

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. 

thrombectomyBased 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.

 

Your opinion matters to us. You are most welcome to leave your comment, reflection, question or any ideas down below.

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...