title: Aspiration thrombectomy prior to percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis.
abstract: Trials of aspiration thrombectomy (AT) prior to primary percutaneous intervention (PCI) in patients with ST-segment elevation MI (STEMI) have shown apparently inconsistent results and therefore generated uncertainty and controversy. To summarize the effects of AT prior to PCI versus conventional PCI in STEMI patients.
  
  
  
  Searches of MEDLINE, EMBASE and CENTRAL to June 2015 and review of reference lists of previous reviews. We included randomized controlled trials (RCTs) comparing AT prior to PCI with conventional PCI alone. Pairs of reviewers independently screened eligible articles; extracted data; and assessed risk of bias. We used the GRADE approach to rate overall certainty of the evidence.
  
  
  
  Among 73 potential articles identified, 20 trials including 21,660 patients were eligible; data were complete for 20,866 patients. Moderate-certainty evidence suggested a non statistically significant decrease in overall mortality (risk ratio (RR) 0.89, 95 % confidence interval, 0.78 to 1.01, risk difference (RD) 4/1,000 over 6 months), no impact on recurrent MI (RR 0.94, 95 % CI, 0.79 to 1.12) or major bleeding (RR 1.02, 95 % CI, 0.78 to 1.35), and an increase in stroke (RR 1.56, 95 % CI, 1.09 to 2.24, RD 3/1,000 over 6 months).
  
  
  
  Moderate certainty evidence suggests aspiration thrombectomy is associated with a possible small decrease in mortality (4 less deaths/1000 over 6 months) and a small increase in stroke (3 more strokes/1000 over 6 months). Because absolute effects are very small and closely balanced, thrombectomy prior to primary PCI should not be used as a routine strategy.
authors.affiliation: Department of Anaesthesiology, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Brazil.|McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Regina
authors.initials: R
authors.lastname: El Dib
authors.affiliation: Division of Cardiology, Department of Medicine, McMaster University, St. Joseph's Healthcare - 50 Charlton Avenue East, Hamilton, Ontario, Canada. fspence@mcmaster.ca.
authors.forename: Frederick Alan
authors.initials: FA
authors.lastname: Spencer
authors.affiliation: Research Institute - Hospital do Coração (HCor), São Paulo, Brazil.
authors.forename: Erica Aranha
authors.initials: EA
authors.lastname: Suzumura
authors.affiliation: Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt.
authors.forename: Huda
authors.initials: H
authors.lastname: Gomaa
authors.affiliation: Division of Cardiology and Heart Education And Research Training (HEART) Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, and Institute of Vascular Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Joey
authors.initials: J
authors.lastname: Kwong
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gordon Henry
authors.initials: GH
authors.lastname: Guyatt
authors.affiliation: Department of Medicine, Innlandet Hospital Trust-Division Gjøvik, Oppland, Norway.|Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Per Olav
authors.initials: PO
authors.lastname: Vandvik
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000209:etiology; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aspiration thrombectomy; GRADE; Meta-analysis; Myocardial infarction; Systematic review