title: Meta-analysis of randomized controlled trials comparing percutaneous coronary intervention with aspiration thrombectomy Vs. Conventional percutaneous coronary intervention during ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Evaluate the impact of aspiration thrombectomy (AT) during primary coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) on clinical outcomes.
  
  
  BACKGROUND
  AT during PCI for STEMI may improve microvascular reperfusion, but its impact on clinical outcomes has remained controversial.
  
  
  METHODS
  We searched Pubmed, EMBASE, Medline, Scopus, CENTRAL, andClinicalTrials.gov databases on March 31, 2015 for randomized controlled trials that evaluated the use of AT with PCI compared with PCI alone for STEMI. The primary end point was all-cause mortality. Secondary end points included major adverse cardiac events (MACE, consisting of death, myocardial infarction, and target-vessel revascularization), recurrent myocardial infarction (MI), target-vessel revascularization (TVR), stent thrombosis and stroke.
  
  
  RESULTS
  Eighteen randomized controlled trials (n = 21,501) fulfilled the inclusion criteria. A total of 10,544 patients were treated with AT and PCI, compared to 10,957 control patients. The use of AT was not associated with a significant decrease in all-cause mortality (RR 0.88; 95% CI 0.78-1.01; P = 0.07), MACE (RR 0.93; 95% CI 0.86-1.00; P = 0.06), recurrent MI (RR 0.97: 95% CI 0.81-1.17; P = 0.77), TVR (RR 0.93; 95% CI 0.82-1.05; P = 0.23), stent thrombosis (RR 0.84; 95% CI 0.66-1.07; P = 0.17), or stroke (RR 1.35; 95% CI 0.86-2.11; P = 0.19).
  
  
  CONCLUSIONS
  Using the totality of evidence available through 2015, this meta-analysis failed to show that the routine use of aspiration thrombectomy in patients with ST-elevation myocardial infarction significantly reduces all-cause mortality, MACE, recurrent MI, TVR, or stent thrombosis. The role of aspiration thrombectomy in selected patients with angiographic evidence of large thrombus burden requires further clinical investigation. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Mount Sinai Saint Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Abel Casso
authors.initials: AC
authors.lastname: Dominguez
authors.affiliation: Ocala Heart Institute, Munroe Regional Medical Center, Ocala, Florida.
authors.forename: John A
authors.initials: JA
authors.lastname: Bittl
authors.affiliation: Mount Sinai Saint Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Georges
authors.initials: G
authors.lastname: El-Hayek
authors.affiliation: Instituto Tecnologico De Santo Domingo, Santo Domingo, Dominican Republic.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Contreras
authors.affiliation: Mount Sinai Saint Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tamis-Holland
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D020521:Stroke / Q000209:etiology; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: STEMI; aspiration thrombectomy; percutaneous coronary intervention