Efficacy and safety of thrombus aspiration in ST-segment elevation myocardial infarction: an updated systematic review and meta-analysis of randomised clinical trials

Abstract

Background: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial. Methods: We performed a meta-analysis of 25 randomised controlled trials in which 21,740 ST-segment elevation myocardial infarction patients were randomly assigned to thrombus aspiration plus primary percutaneous coronary intervention or primary percutaneous coronary intervention. Study endpoints were: death, myocardial infarction, stent thrombosis and stroke. Results: On pooled analysis, the risk of death (4.3% vs. 4.8%, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.79-1.03; P=0.123), myocardial infarction (2.4% vs. 2.5%, OR 0.95, 95% CI 0.80-1.13; P=0.57) and stent thrombosis (1.3% vs. 1.6%, OR 0.80, 95% CI 0.63-1.01; P=0.066) was similar between thrombus aspiration plus primary percutaneous coronary intervention and primary percutaneous coronary intervention. The risk of stroke was higher in the thrombus aspiration plus primary percutaneous coronary intervention than the primary percutaneous coronary intervention group (0.84% vs. 0.59%, OR 1.401, 95% CI 1.004-1.954; P=0.047). However, on sensitivity analysis after removing the TOTAL trial, thrombus aspiration plus primary percutaneous coronary intervention was not associated with an increased risk of stroke (OR 1.01, 95% CI 0.58-1.78). The weak association between thrombus aspiration and stroke was also confirmed by the fact that the lower bound of the 95% CI was slightly below unity after removing either the study by Kaltoft or the ITTI trial. There was no interaction between the main study results and follow-up, evidence of coronary thrombus, or study sample size. Conclusions: In patients with ST-segment elevation myocardial infarction, thrombus aspiration plus primary percutaneous coronary intervention does not reduce the risk of death, myocardial infarction or stent thrombosis. Thrombus aspiration plus primary percutaneous coronary intervention is associated with an increased risk of stroke; however, this latter finding appears weak.

Thrombus aspiration in hyperglycemic ST-elevation myocardial infarction (STEMI) patients: clinical outcomes at 1-year follow-up

“…Despite its strong data and intuitive basis for incremental value of TA in hyperglycemic patients, results from pivotal trials and “real-world” registries of manual thrombectomy have not consistently demonstrated clinical benefits over standard PPCI in general population [ 20 , 26 , 27 ]. However, all these studies did not provide any evidence about the effects of TA in a subgroup of high-risk STEMI patients, such as those with hyperglycemia during the event.…”

Value of the platelet-to-lymphocyte ratio in the prediction of left ventricular thrombus in anterior ST-elevation myocardial infarction with left ventricular dysfunction

“…In addition, compared to Rabbani’s study, the DTBT in our no-LVT group was relatively short, which might potentially reduce the influence of delayed reperfusion. Although thrombectomy was not recommended in routine application [ 21 ], De Rosa, S. et al [ 22 , 23 ] showed that thrombectomy had important positive effects on long-term clinical outcome in high-risk patients with AMI, and its effect became relevant in late presenters, suggesting that thrombectomy might be helpful in selected subpopulations at higher clinical risk. However, in our study, patients who were treated with thrombectomy showed no significant difference in the occurrence of LVT.…”

Successful manual thrombus aspiration in anterior ST-segment elevation myocardial infarction due to cardioembolic obstruction of the left main coronary artery

“…However, recent data from an individual level meta-analysis including patients from the TAPAS, TASTE, and TOTAL trials suggested that some categories of patients such as those with a large thrombus burden may still benefit from TA [6]. In a recently published updated meta-analysis we have shown that the incidence of stroke in patients treated with TA is 0.84% compared to 0.59% observed in patients with no TA (number needed to harm 423) [8]. Although rare, the risk of stroke is real and we suggest to use TA only in cases of conventional PCI failure.…”