Abstract 5612: Embolic Protection Devices in Acute Myocardial Infarction. Do They Confer the Same Clinical Benefit?
Background Thromboembolic debris liberated during primary percutaneous coronary intervention (PCI) may result in impaired clinical outcomes. Conflicting data from randomized control trials (RCT’s) have precluded the widespread application of embolic protection devices (EPD’s) to complement primary PCI. Furthermore, current guidelines do not recommend routine use of EPD’s in this setting and longer follow-up data are lacking.
Objective The aim of this study was to combine data from all RCT’s using EPD’s in patients presenting with ST-elevation myocardial infarction (STEMI). The primary end-point of our meta-analysis was to assess the impact of EPD’s on survival at 6 months.
Methods Data from 8 RCT’s, including 2527 patients (pts), were analyzed. EPD’s used aspiration in 3 studies (De Luca, DEAR-MI, TAPAS; N=1295 pts), thrombectomy in 1 (X AMINE ST; N=201 pts), and filters in 4 (DIPLOMAT, ASPARAGUS, EMERALD, PREMIAR; N=1031 pts). In total, 1268 pts underwent active treatment and 1259 were controls.
Results As shown in Table 1⇓, at 6 months the use of aspiration significantly reduced (by 51%) the risk of death. On the contrary, no benefit was derived from the use of either thrombectomy or filters. There was homogeneity among the trials, and when comparing the different types of EPD’s.
Conclusion Aspiration devices, but not thrombectomy or filters, improve mid term mortality of STEMI patients undergoing primary PCI. This translates into 34 lives saved per 1000 patients treated.