title: Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention? Meta-Analysis of Randomized Trials.
abstract: BACKGROUND
  It is unclear whether intravenous glycoprotein IIb/IIIa inhibitors or ischemic time might modify any clinical benefits observed with aspiration thrombectomy before primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction.
  
  
  RESULTS
  Electronic databases were searched for trials that randomized ST-segment-elevation myocardial infarction patients to aspiration thrombectomy before PCI versus conventional PCI. Summary estimates were constructed using a DerSimonian-Laird model. Seventeen trials with 20 960 patients were available for analysis. When compared with conventional PCI, aspiration thrombectomy was not associated with a significant reduction in the risk of mortality 2.8% versus 3.2% (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.76-1.04; P=0.13), reinfarction 1.3% versus 1.4% (RR, 0.93; 95% CI, 0.73-1.17; P=0.52), the combined outcome of mortality or reinfarction 4.1% versus 4.6% (RR, 0.90; 95% CI, 0.79-1.02; P=0.11), or stent thrombosis 0.9% versus 1.2% (RR, 0.82; 95% CI, 0.62-1.08; P=0.15). Aspiration thrombectomy was associated with a nonsignificant increase in the risk of stroke 0.6% versus 0.4% (RR, 1.45; 95% CI, 0.96-2.21; P=0.08). Meta-regression analysis did not identify a difference for the log RR of mortality, reinfarction, and the combined outcome of mortality or reinfarction with intravenous glycoprotein IIb/IIIa inhibitors (P=0.17, 0.70, and 0.50, respectively) or with ischemic time (P=0.29, 0.66, and 0.58, respectively).
  
  
  CONCLUSIONS
  Aspiration thrombectomy before primary PCI is not associated with any benefit on clinical end points and might increase the risk of stroke. Concomitant administration of intravenous glycoprotein IIb/IIIa inhibitors and ischemic time did not seem to influence any potential benefits observed with aspiration thrombectomy.
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., T.H., A.A.B.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Medicine Service, North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., T.H., A.A.B.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Medicine Service, North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
authors.forename: Tianyao
authors.initials: T
authors.lastname: Huo
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., T.H., A.A.B.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Medicine Service, North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Department of Medicine, University of Florida, Gainesville (I.Y.E., T.H., A.A.B.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Medicine Service, North Florida/South Georgia Veterans Health System, Gainesville (A.A.B.). anthony.bavry@va.gov.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
mesh_terms: D006801:Humans; D009026:Mortality; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012044:Regression Analysis; D020521:Stroke / Q000473:pathology; D013318:Stroke Volume / Q000502:physiology; D017131:Thrombectomy
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: meta-analysis; myocardial infarction; percutaneous coronary intervention; stroke; thrombectomy