Clinical Outcomes of Manual Aspiration Thrombectomy in Patients with Acute Myocardial Infarction: An Updated Meta-Analysis

Abstract

Background: Recent trials on manual aspiration thrombectomy (AT) in patients with ST-elevation myocardial infarction did not show any significant benefits of AT. Aims: The present meta-analysis was designed to systematically evaluate prospective randomized trials and assess the effects of AT on all-cause mortality, major cardiovascular events (MACE), target vessel revascularization, myocardial reinfarction, stroke and surrogate myocardial perfusion markers. Methods and Results: We conducted an EMBASE and MEDLINE search for studies in which patients were randomized to treatment with AT plus primary percutaneous coronary intervention (PCI) versus PCI. We identified 16 prospective randomized trials which enrolled 10,437 controls that underwent conventional PCI and 10,385 patients who underwent PCI with AT with an average follow-up duration of 5.8 months. A significant reduction in MACE with AT was noted (OR 0.91; 95% CI 0.82-0.99; p = 0.04). In spite of improved TIMI 3 and myocardial blush grade 3 rates, AT did not significantly reduce all-cause mortality, target-vessel revascularization and myocardial infarction. Stroke rates were increased with AT. Conclusion: The results of this large meta-analysis of 20,822 patients suggest that adjunctive AT to PCI may be associated with improved myocardial reperfusion but limited benefits related to the clinical end-points.

Manual thromboaspiration during primary percutaneous intervention in the Brazilian practice

“…19 Além disto, metanálise realizada em seguida incluindo resultados do TASTE ainda demonstrava benefício do uso rotineiro do AMT. 20 Somente com a publicação do estudo TOTAL, em 2015, que marca o terceiro período analisado em nossa pesquisa, o AMT caiu em desuso. Este estudo clínico randomizado, controlado, com adjudicação de eventos, e amostra suficiente para avaliar desfechos clínicos (10.732 pacientes), demonstrou que não havia benefício clínico do uso rotineiro do AMT na ICP primária.…”

Impact of intracoronary contrast injection pressure on reperfusion during primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: A prospective randomized pilot study

“…Nowadays, the prevention and treatment of no-reflow phenomenon is being carried out by using different therapeutic strategies, however due to the complex interaction of factors, it is unlikely that a single method could be effective in all patients [[18], [19], [20], [21]]. Regarding the mechanical methods, repetitive balloon inflations during primary PCI seem to be cardioprotective, whereas on the basis of large meta-analysis of 20,822 patients it seems that additional thrombus aspiration during primary PCI may be linked to improved myocardial reperfusion but with no benefits in relation to the clinical outcome [22,23]. Use of distal protection devices and intracoronary drugs make no significant improvements in relation to a lower risk of major adverse cardiac events [21,24,25].…”

A mechanism for stroke complicating thrombus aspiration

“…Initially it was associated with decreased mortality in randomized trials and meta‐analyses . More recently, larger trials , meta‐analyses , and large registries with over 27,000 patients have found no improvement in clinical endpoints with CTA. As a consequence, updated STEMI guidelines downgraded routine CTA in STEMI from a Class IIa recommendation to a Class III recommendation .…”

“…A strategy of selective thrombus aspiration might seem relatively harmless, except for recent data suggesting that thrombus aspiration may be associated with stroke . This was not demonstrated in 4 single‐country studies , raising a question as to whether technique may play a role.…”

“…Thrombus aspiration was associated with increased risk of stroke in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL), which randomized patients with ST elevation myocardial infarction (STEMI) to routine thrombus aspiration plus primary percutaneous coronary intervention (PPCI) versus PPCI alone . Two meta‐analyses which included TOTAL reported increased risk of stroke in patients undergoing routine thrombus aspiration during STEMI PPCI with odds ratio of 1.6 ( P = 0.009) or 1.45 ( P = 0.08) .…”