title: Aspiration Thrombectomy in Patients Undergoing Primary Angioplasty for ST Elevation Myocardial Infarction: An Updated Meta-Analysis.
abstract: BACKGROUND
  The Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in patients with STEMI (TOTAL trial) refuted the salutary effect of routine aspiration thrombectomy (AT) in PPCI for patients with ST-elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  We performed an updated meta-analysis to assess clinical outcomes with AT prior to PPCI compared with conventional PPCI alone including the additional trial data.
  
  
  RESULTS
  Clinical trials (n = 20) that randomized patients (n = 21,281) with STEMI between Routine AT (n = 10,619) and PPCI (n = 10,662) were pooled. There was no difference in all-cause mortality between the 2 groups (RR: 0.89, 95%CI: 0.78-1.01, P = 0.08). Stratifying by follow up at 1-month (RR: 0.87, 95%CI: 0.69-1.10, P = 0.25), up to 6 months (RR: 0.91, 95%CI: 0.74-1.13, P = 0.39 and beyond 6 months (RR: 0.88, 95%CI: 0.74-1.05, P = 0.16) yielded similar results. There was a statistically significant increase risk of stoke rate in the AT arm (RR: 1.51, 95%CI: 1.01-2.25, P = 0.04). The 2 groups were similar with regards to target vessel revascularization (0.94, 95%CI: 0.83-1.06, P = 0.28) recurrent MI (RR: 0.96, 95%CI: 0.80-1.16, P = 0.68, MACE events (RR: 0.91 95%CI: 0.81-1.02, P = 0.11), early (0.59, 95%CI: 0.23-1.50, P = 0.27) and late (RR: 0.91, 95%CI: 0.69-1.18, P = 0.47) stent thrombosis and net clinical benefit (RR 0.99, 95%CI: 0.91-1.07, P = 0.76).
  
  
  CONCLUSIONS
  Routine AT prior to PPCI in STEMI is associated with higher risk of stroke. There is no statistical difference in clinical outcome parameters of mortality, major adverse cardiac events, target vessel revascularization, stent thrombosis, and net clinical benefit between AT and PCI alone.
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ghatak
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, and University of Iowa Hospitals and Clinics, Iowa City, Iowa.|The Wright Center for Graduate Medical Education, Scranton, Pennsylvania.
authors.forename: Ghanshyam Palamaner Subash
authors.initials: GP
authors.lastname: Shantha
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: The Wright Center for Graduate Medical Education, Scranton, Pennsylvania.
authors.forename: Monodeep
authors.initials: M
authors.lastname: Biswas
authors.affiliation: The Wright Center for Graduate Medical Education, Scranton, Pennsylvania.
authors.forename: Samir Bipin
authors.initials: SB
authors.lastname: Pancholy
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Marchena
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
mesh_terms: D017130:Angioplasty; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D020521:Stroke / Q000209:etiology; D017131:Thrombectomy