Abstract 17864: Role of Aspiration and Mechanical Thrombectomy in Patients with Acute Myocardial Infarction Undergoing Primary Angioplasty: An Updated Meta-Analysis of Randomized Trials
Objectives: Trials of thrombectomy in acute MI have focused on surrogate markers of reperfusion; however, clinical efficacy remains uncertain. We conducted an updated meta-analysis on clinical outcomes with thrombectomy prior to primary percutaneous coronary intervention (PPCI) compared with PPCI alone.
Methods: Clinical trials that randomized AMI patients to either aspiration (e.g. Export catheter)/mechanical (e.g. Angiojet) thrombectomy prior to PPCI compared with PPCI alone were included.
Results: We included 5,534 patients from 25 trials (1,944 aspiration thrombectomy, 779 mechanical thrombectomy, 2,811 PPCI). Weighted mean duration of follow-up was 6 months. Aspiration thrombectomy vs. PPCI: Mortality was significantly reduced with aspiration thrombectomy (2.6% vs. 3.6%; Risk ratio [RR] 0.71, 95% CI 0.50-1.00; p=0.05; NNT: 84) (Figure a). Beneficial trends were also noted for MI (p=0.07) and target vessel revascularization (TVR) (p=0.07). Infarct size within 3 months on SPECT/cardiac MRI was similar (p=0.64). ST-segment resolution (STR) at 60 minutes (RR=1.26; 95% CI 1.17-1.35; p<0.0001) and TIMI blush grade (TBG) 3 post-procedure (RR=1.31; 95% CI 1.24-1.39; p<0.0001) were both improved in the aspiration thrombectomy arm. Mechanical thrombectomy vs. PPCI: There was no difference between the thrombectomy and PPCI arms in the incidence of mortality (4.1% vs. 3.3%; RR=1.17; 95% CI 0.71-1.93; p=0.54) (Figure b), MI (p=0.42), TVR (p=0.21), or infarct size on SPECT/MRI (p=0.47). A benefit in STR at 60 minutes (RR=1.15; 95% CI 1.07-1.23; p<0.0001), but not TBG 3 (RR=0.99; 95% CI 0.90-1.10; p=0.91) was noted.
Conclusions: Thrombectomy by manual catheter aspiration during AMI is beneficial in improving markers of myocardial reperfusion and reducing mortality compared with PCI alone. Mechanical thrombectomy has a neutral effect, except for a slight improvement in STR at 60 minutes. Neither device type appears to affect infarct size at 3 months.
- Myocardial infarction, STEMI
- Percutaneous coronary intervention
- Clinical trials
- Interventional cardiology
- © 2012 by American Heart Association, Inc.