title: Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty: an updated meta-analysis of randomized trials.
abstract: OBJECTIVE
  This meta-analysis was designed to update data on clinical outcomes with aspiration thrombectomy or mechanical thrombectomy before primary percutaneous coronary intervention (PCI) compared with conventional primary PCI alone.
  
  
  BACKGROUND
  The clinical efficacy of thrombectomy in acute myocardial infarction (AMI) remains uncertain.
  
  
  METHODS
  Clinical trials that randomized AMI patients to aspiration (18 trials, n = 3,936) or mechanical thrombectomy (7 trials, n = 1,598) before PCI compared with conventional PCI alone were included.
  
  
  RESULTS
  The weighted mean duration of clinical follow-up was 6 months. Aspiration thrombectomy vs. conventional primary PCI (18 trials, n=3,936): Major adverse cardiac events (MACE) (risk ratio [RR]: 0.76; 95% confidence interval [CI]: 0.63 to 0.92; p = 0.006) and all-cause mortality (RR: 0.71; 95% CI: 0.51 to 0.99; p = 0.049) were significantly reduced with aspiration thrombectomy. Beneficial trends were noted for recurrent MI (p = 0.11) and target vessel revascularization (p = 0.06). Final infarct size (p = 0.64) and ejection fraction (p = 0.32) at 1 month were similar. ST-segment resolution (STR) at 60 min (RR: 1.31; 95% CI: 1.16 to 1.48; p < 0.0001) and Thrombolysis In Myocardial Infarction blush grade (TBG) 3 post-procedure (RR: 1.37; 95% CI: 1.19 to 1.59; p < 0.0001) were both improved with aspiration thrombectomy. Mechanical thrombectomy vs. conventional primary PCI (7 trials, n = 1,598): there was no difference between the mechanical thrombectomy and conventional primary PCI arms in the incidence of MACE (RR: 1.10; 95% CI: 0.59 to 2.05; p = 0.77), mortality (p = 0.57), recurrent MI (p = 0.32), target vessel revascularization (p = 0.19), or final infarct size (p = 0.47). A benefit in STR at 60 min (RR: 1.25; 95% CI: 1.06 to 1.47; p = 0.007), but not TBG 3 (RR: 1.09; 95% CI: 0.86 to 1.38; p = 0.48) was noted.
  
  
  CONCLUSIONS
  Thrombectomy during AMI by manual catheter aspiration, but not mechanically, is beneficial in reducing MACE, including mortality, at 6 to 12 months compared with conventional primary PCI alone.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: dharam@post.harvard.edu.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D057186:Comparative Effectiveness Research; D016001:Confidence Intervals; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods / Q000706:statistics & numerical data; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control
keywords: CK; CMR; DE; MACE; PCI; SPECT; ST-segment elevation myocardial infarction; STEMI; WMD; cardiac magnetic resonance imaging; creatine kinase; delayed enhancement; major adverse cardiac event(s); meta-analysis; mortality; myocardial infarction; outcomes; percutaneous coronary intervention; single-photon emission computed tomography; thrombectomy; weighted mean difference