Aspiration thrombectomy in patients undergoing primary angioplasty: Totality of data to 2013

Dharam J. Kumbhani, Anthony A. Bavry, Milind Y. Desai, Sripal Bangalore, Robert A. Byrne, Hani Jneid, Deepak L. Bhatt

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Objectives: We sought to update our meta-analysis on clinical outcomes with aspiration thrombectomy prior to primary percutaneous coronary intervention (PPCI) compared with conventional PPCI alone due to the availability of additional trial data. Background: The clinical efficacy of adjunctive aspiration thrombectomy in STelevation myocardial infarction (STEMI) patients undergoing PPCI remains controversial. A recent large-scale randomized trial showed no benefit in terms of mortality at 30 days. Methods: Clinical trials that randomized STEMI patients to aspiration thrombectomy prior to PPCI compared with conventional PPCI alone were included. Results: A total of 11,321 patients from 20 randomized controlled trials were included. The composite major adverse cardiac event (MACE) endpoint was lower in the aspiration thrombectomy arm compared with conventional PPCI alone (risk ratio [RR]50.81, 95% CI 0.70-0.94; P50.006). Although all-cause mortality was similar between the adjunctive aspiration thrombectomy arm and PPCI arms (RR50.83, 95% CI 0.67-1.01; P50.06), late mortality (6-12 months) was significantly reduced (RR50.64; 95% CI 0.44-0.92; P50.016). Reinfarction (RR50.64, 95% CI 0.44-0.92; P50.017) and stent thrombosis (RR50.54; 95% CI 0.32-0.91; P50.021) were similarly lower. Differences in target vessel revascularization were of borderline significance (RR50.83, 95% CI 0.68- 1.01; P50.06). Conclusions: Our meta-analysis including all randomized controlled trials on aspiration thrombectomy to date demonstrates a significant reduction in adverse clinical outcomes including stent thrombosis compared with conventional PCI alone.

Original languageEnglish (US)
Pages (from-to)973-977
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume84
Issue number6
DOIs
StatePublished - Nov 15 2014

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Keywords

  • Meta-analysis
  • Mortality
  • Myocardial infarction
  • Outcomes
  • Thrombectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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