El Dib Regina, Spencer Frederick Alan, Suzumura Erica Aranha, Gomaa Huda, Kwong Joey, Guyatt Gordon Henry, Vandvik Per Olav
Department of Anaesthesiology, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Brazil.
McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada.
BMC Cardiovasc Disord. 2016 Jun 2;16:121. doi: 10.1186/s12872-016-0285-4.
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.
在ST段抬高型心肌梗死（STEMI）患者中，在直接经皮冠状动脉介入治疗（PCI）之前进行抽吸血栓切除术（AT）的试验结果明显不一致，因此产生了不确定性和争议。总结在STEMI患者中，PCI前AT与传统PCI相比的效果。
检索截至2015年6月的MEDLINE、EMBASE和CENTRAL数据库，并查阅以往综述的参考文献列表。我们纳入了比较PCI前AT与单纯传统PCI的随机对照试验（RCT）。由两名评价者独立筛选符合条件的文章；提取数据；并评估偏倚风险。我们采用GRADE方法对证据的总体确定性进行分级。
在73篇潜在文章中，20项试验（包括21,660例患者）符合条件；20,866例患者的数据完整。中等确定性证据表明，总体死亡率无统计学意义的降低（风险比（RR）0.89，95%置信区间为0.78至1.01，6个月内风险差（RD）为4/1000），对再发心肌梗死（RR 0.94，95%CI为0.79至1.12）或大出血（RR 1.02，95%CI为0.78至1.35）无影响，而卒中发生率增加（RR 1.56，95%CI为1.09至2.24，6个月内RD为3/1000）。
中等确定性证据表明，抽吸血栓切除术可能与死亡率小幅降低（6个月内每1000例死亡减少4例）和卒中小幅增加（6个月内每1000例卒中增加3例）相关。由于绝对效应非常小且利弊相当，直接PCI前的血栓切除术不应作为常规策略。
