title: Thrombus aspiration in patients with ST elevation myocardial infarction: meta-analysis of 16 randomized trials.
abstract: OBJECTIVE
  The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone.
  
  
  METHODS
  Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke.
  
  
  RESULTS
  Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups.
  
  
  CONCLUSIONS
  This meta-analysis is the first updated analysis after publishing the 1-year result of the "Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction" trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Atatürk University; Erzurum-Turkey. haliltanboga@yahoo.com.
authors.forename: İbrahim Halil
authors.initials: İH
authors.lastname: Tanboğa
authors.forename: Selim
authors.initials: S
authors.lastname: Topçu
authors.forename: Enbiya
authors.initials: E
authors.lastname: Aksakal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kurt
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kaya
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Serdar
authors.initials: S
authors.lastname: Sevimli
mesh_terms: D003328:Coronary Thrombosis / Q000150:complications / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome