Adjunctive thrombectomy for acute myocardial infarction: A bayesian meta-analysis.
BACKGROUND
In available trials and meta-analyses, adjunctive thrombectomy in acute myocardial infarction (MI) improves markers of myocardial reperfusion but has limited effects on clinical outcomes. Thrombectomy devices simply aspirate thrombus or mechanically fragment it before aspiration. Simple aspiration thrombectomy may offer a distinct advantage.


RESULTS
We identified 21 eligible trials (16 that used a simple aspiration thrombectomy device) involving 4299 patients with ST-segment elevation MI randomized to reperfusion therapy by primary percutaneous coronary intervention with or without thrombectomy. By using Bayesian meta-analysis methods, we found that thrombectomy yielded substantially less no-reflow (odds ratio [OR], 0.39; 95% credible interval [CrI], 0.18 to 0.69), more ST-segment resolution > or =50% (OR, 2.22; 95% CrI, 1.60 to 3.23), and more thrombolysis in myocardial infarction/myocardial perfusion grade 3 (OR, 2.50; 95% CrI, 1.48 to 4.41). There was no evidence for a decrease in death (OR, 0.94; 95% CrI, 0.47 to 1.80), death, recurrent MI, or stroke (OR, 1.07; 95% CrI, 0.63 to 1.92) with thrombectomy. Restriction of the analysis to trials that used simple aspiration thrombectomy devices did not yield substantially different results, except for a positive effect on postprocedure thrombolysis in myocardial infarction grade 3 flow (OR, 1.49; 95% CrI, 1.14 to 1.99).


CONCLUSIONS
In this Bayesian meta-analysis, adjunctive thrombectomy improves early markers of reperfusion but does not substantially effect 30-day post-MI mortality, reinfarction, and stroke. The use of aspiration thrombectomy devices is not associated with a reduction in post-MI clinical outcomes. Thrombectomy is one of the rare effective preventive measures against no-reflow.
Mongeon
François-Pierre
FP
Department of Medicine, Echocardiography, and Noninvasive Cardiology Service, Montreal Heart Institute, Canada.
Bélisle
Patrick
P
Joseph
Lawrence
L
Eisenberg
Mark J
MJ
Rinfret
Stéphane
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001499:Bayes Theorem; D018450:Disease Progression; D004562:Electrocardiography; D004864:Equipment and Supplies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D054318:No-Reflow Phenomenon / Q000628:therapy*; D020521:Stroke; D016019:Survival Analysis; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data