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 Citations (Scopus)

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

Fingerprint

Thrombectomy
Percutaneous Coronary Intervention
Angioplasty
Randomized Controlled Trials
Stents
Meta-Analysis
Mortality
Thrombosis
Myocardial Infarction
Odds Ratio

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Aspiration thrombectomy in patients undergoing primary angioplasty : Totality of data to 2013. / Kumbhani, Dharam J.; Bavry, Anthony A.; Desai, Milind Y.; Bangalore, Sripal; Byrne, Robert A.; Jneid, Hani; Bhatt, Deepak L.

In: Catheterization and Cardiovascular Interventions, Vol. 84, No. 6, 15.11.2014, p. 973-977.

Research output: Contribution to journalArticle

Kumbhani, Dharam J. ; Bavry, Anthony A. ; Desai, Milind Y. ; Bangalore, Sripal ; Byrne, Robert A. ; Jneid, Hani ; Bhatt, Deepak L. / Aspiration thrombectomy in patients undergoing primary angioplasty : Totality of data to 2013. In: Catheterization and Cardiovascular Interventions. 2014 ; Vol. 84, No. 6. pp. 973-977.
@article{fbe6c7755de24c3f960b689b6c35d3f6,
title = "Aspiration thrombectomy in patients undergoing primary angioplasty: Totality of data to 2013",
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.",
keywords = "Meta-analysis, Mortality, Myocardial infarction, Outcomes, Thrombectomy",
author = "Kumbhani, {Dharam J.} and Bavry, {Anthony A.} and Desai, {Milind Y.} and Sripal Bangalore and Byrne, {Robert A.} and Hani Jneid and Bhatt, {Deepak L.}",
year = "2014",
month = "11",
day = "15",
doi = "10.1002/ccd.25532",
language = "English (US)",
volume = "84",
pages = "973--977",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "6",

}

TY - JOUR

T1 - Aspiration thrombectomy in patients undergoing primary angioplasty

T2 - Totality of data to 2013

AU - Kumbhani, Dharam J.

AU - Bavry, Anthony A.

AU - Desai, Milind Y.

AU - Bangalore, Sripal

AU - Byrne, Robert A.

AU - Jneid, Hani

AU - Bhatt, Deepak L.

PY - 2014/11/15

Y1 - 2014/11/15

N2 - 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.

AB - 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.

KW - Meta-analysis

KW - Mortality

KW - Myocardial infarction

KW - Outcomes

KW - Thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=84930064273&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930064273&partnerID=8YFLogxK

U2 - 10.1002/ccd.25532

DO - 10.1002/ccd.25532

M3 - Article

C2 - 24782350

AN - SCOPUS:84930064273

VL - 84

SP - 973

EP - 977

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 6

ER -