A Bayesian meta-analysis comparing AngioJet thrombectomy to percutaneous coronary intervention alone in acute myocardial infarction.
OBJECTIVE
The purpose of this meta-analysis was to compare outcomes for AngioJet thrombectomy versus percutaneous coronary intervention (PCI) without thrombectomy in acute myocardial infarction (AMI) patients.


BACKGROUND
PCI is the preferred treatment for revascularizing the infarct-related artery in patients with AMI. There is controversy about the benefits of thrombectomy as an adjunct to PCI.


METHODS
AMI studies published between January 1, 1999, and March 1, 2007, were used to compare AngioJet thrombectomy plus PCI to PCI alone. Bayesian meta-analytic estimates were used to estimate the odds ratios (95% CI) for short-term mortality, major adverse cardiac events (MACE), and final TIMI 3 flow.


RESULTS
The AngioJet data included 11 studies and 1,018 patients. The PCI data included 81 studies and 24,076 patients. The AngioJet group included more patients with large thrombus burden, rescue PCI after failed thrombolytic therapy, and longer symptom duration compared to the PCI group. Despite the higher risk profile of AngioJet patients, the groups had similar odds of short-term mortality, 0.98 (0.53, 1.50), MACE, 1.25 (0.54, 2.40), and final TIMI 3 flow, 1.12 (0.70, 2.27).


CONCLUSIONS
AngioJet thrombectomy results in clinical and angiographic outcomes that are similar to PCI in lower risk AMI patients. These observations suggest that AngioJet thrombectomy may reduce the additional risk associated with visible thrombus in the infarct-related lesion.
Grines
Cindy L
CL
Division of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073, USA. cgrines@beaumont.edu
Nelson
Teresa R
TR
Safian
Robert D
RD
Hanzel
George
G
Goldstein
James A
JA
Dixon
Simon
S
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D001499:Bayes Theorem; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D017131:Thrombectomy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome