Abstract | AIMS: The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. Growing interests are on manual thrombectomy devices as compared with other mechanical devices. In fact, they are inexpensive and user-friendly devices, and thus represent an attractive strategy. The aim of the current study was to perform an updated meta-analysis of randomized trials conducted with adjunctive manual thrombectomy devices to prevent distal embolization in AMI. METHODS AND RESULTS: The literature was scanned by formal searches of electronic databases [MEDLINE, CENTRAL, EMBASE, and The Cochrane Central Register of Controlled trials (http://www.mrw.interscience.wiley.com/cochrane/Cochrane_clcentral_articles_fs.html)] from January 1990 to May 2008, the scientific session abstracts (from January 1990 to May 2008) and oral presentation and/or expert slide presentations (from January 2002 to May 2008) [on transcatheter coronary therapeutics (TCT), AHA (American Heart Association), ESC (European Society of Cardiology), ACC (American College of Cardiology) and EuroPCR websites]. We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following keywords were used: randomized trial, myocardial infarction, reperfusion, primary angioplasty, rescue angioplasty, thrombectomy, thrombus aspiration, manual thrombectomy, Diver catheter, Pronto catheter, Export catheter, thrombus vacuum aspiration catheter. Information on study design, type of device, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by two investigators. Disagreements were resolved by consensus. A total of nine trials with 2417 patients were included [1209 patients (50.0%) in the manual thrombectomy device group and 1208 (50%) in the control group]. Adjunctive manual thrombectomy was associated with significantly improved postprocedural TIMI (thrombolysis in myocardial infarction) 3 flow (87.1 vs. 81.2%, P < 0.0001), and postprocedural MBG 3 (myocardial blush grade 3) (52.1 vs. 31.7%, P < 0.0001), less distal embolization (7.9 vs. 19.5%, P < 0.0001), and significant benefits in terms of 30-day mortality (1.7 vs. 3.1%, P = 0.04). CONCLUSION:
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Authors | Giuseppe De Luca, Dariusz Dudek, Gennaro Sardella, Paolo Marino, Bernard Chevalier, Felix Zijlstra |
Journal | European heart journal
(Eur Heart J)
Vol. 29
Issue 24
Pg. 3002-10
(Dec 2008)
ISSN: 1522-9645 [Electronic] England |
PMID | 18775918
(Publication Type: Journal Article, Meta-Analysis, Review, Validation Study)
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Topics |
- Angioplasty, Balloon, Coronary
(methods, mortality)
- Cardiac Catheterization
(methods)
- Coronary Angiography
- Coronary Thrombosis
(mortality, therapy)
- Embolization, Therapeutic
(methods, mortality)
- Endpoint Determination
- Female
- Humans
- Male
- Myocardial Infarction
(mortality, therapy)
- Myocardial Reperfusion
(mortality)
- Randomized Controlled Trials as Topic
- Survival Analysis
- Thrombectomy
(methods, mortality)
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