Effects of aspiration thrombectomy on mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis of the randomized trials.
BACKGROUND
Thrombus removal using aspiration-thrombectomy (AT) may improve outcomes in Acute Myocardial Infarction (AMI). We performed a meta-analysis of randomized trials evaluating AT during primary Percutaneous Coronary Intervention (PCI) to determine its impact on mortality and morbidity.


METHODS
Studies were included if they were randomized trials evaluating AT versus control in patients with AMI undergoing primary-PCI. Databases were searched for eligible studies (1990-February 2008). Efficacy outcomes including death as a primary and composite of death, re-MI, stroke and repeat revascularization as a secondary outcome were evaluated at follow-up. Trials were combined using a fixed effects model and heterogeneity was evaluated.


RESULTS
18 trials involving 3871 patients were included. At average follow up of 8.9 months, mortality was significantly reduced in favour of AT (2.9% vs. 4.2%, OR 0.70, CI 0.49-0.99, P=0.04). The secondary outcome of composite of death, MI or stroke at average follow up of 8.9 months was not significantly reduced (5.6% vs. 7.1%, P=0.08) while the secondary outcome of death, MI, stroke, TVR & bleeding was significantly reduced (11% vs. 13.6% OR 0.77, CI 0.63-0.99, P 0.01) in the AT group. Thrombectomy devices were associated with a higher rate of thrombolysis in myocardial infarction 3 flow (OR 1.42; CI 1.17-1.72), Myocardial Blush Grade 3 flow (2.01; 1.74-2.31) and ST resolution (2.40; 2.08-2.78). There was no significant heterogeneity in any of the outcomes.


CONCLUSIONS
In primary PCI, the addition of AT reduces both mortality and recurrent ischemic events at follow up. These benefits are associated with improved early infarct-related artery patency.
Lanjewar
Charan
C
Seth G.S. Medical College & KEM Hospital, Mumbai, India. charanlanjewar@hotmail.com
Jolly
Sanjit
S
Mehta
Shamir R
SR
D015906:Angioplasty, Balloon, Coronary; D003328:Coronary Thrombosis / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013396:Suction; D017131:Thrombectomy; D016896:Treatment Outcome