Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention? Meta-Analysis of Randomized Trials.

Abstract

BACKGROUND:

It is unclear whether intravenous glycoprotein IIb/IIIa inhibitors or ischemic time might modify any clinical benefits observed with aspiration thrombectomy before primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction.

METHODS AND RESULTS:

Electronic databases were searched for trials that randomized ST-segment-elevation myocardial infarction patients to aspiration thrombectomy before PCI versus conventional PCI. Summary estimates were constructed using a DerSimonian-Laird model. Seventeen trials with 20 960 patients were available for analysis. When compared with conventional PCI, aspiration thrombectomy was not associated with a significant reduction in the risk of mortality 2.8% versus 3.2% (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.76-1.04; P=0.13), reinfarction 1.3% versus 1.4% (RR, 0.93; 95% CI, 0.73-1.17; P=0.52), the combined outcome of mortality or reinfarction 4.1% versus 4.6% (RR, 0.90; 95% CI, 0.79-1.02; P=0.11), or stent thrombosis 0.9% versus 1.2% (RR, 0.82; 95% CI, 0.62-1.08; P=0.15). Aspiration thrombectomy was associated with a nonsignificant increase in the risk of stroke 0.6% versus 0.4% (RR, 1.45; 95% CI, 0.96-2.21; P=0.08). Meta-regression analysis did not identify a difference for the log RR of mortality, reinfarction, and the combined outcome of mortality or reinfarction with intravenous glycoprotein IIb/IIIa inhibitors (P=0.17, 0.70, and 0.50, respectively) or with ischemic time (P=0.29, 0.66, and 0.58, respectively).

CONCLUSIONS:

Aspiration thrombectomy before primary PCI is not associated with any benefit on clinical end points and might increase the risk of stroke. Concomitant administration of intravenous glycoprotein IIb/IIIa inhibitors and ischemic time did not seem to influence any potential benefits observed with aspiration thrombectomy.

• Authors: Islam Y Elgendy, Tianyao Huo, Deepak L Bhatt, Anthony A Bavry
• Journal: Circulation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 8 Issue 7 Pg. e002258 (Jul 2015) ISSN: 1941-7632 [Electronic] United States
• PMID: 26175531 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2015 American Heart Association, Inc.

Chemical References

• Platelet Glycoprotein GPIIb-IIIa Complex

Topics

• Humans
• Mortality
• Myocardial Infarction (drug therapy, mortality, surgery)
• Percutaneous Coronary Intervention (adverse effects, methods)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Randomized Controlled Trials as Topic
• Recurrence
• Regression Analysis
• Stroke (pathology)
• Stroke Volume (physiology)
• Thrombectomy