Thrombus aspiration in STEMI patients: an updated systematic review and meta-analysis.

INTRODUCTION

Clinical efficacy and safety of adjunctive thrombus aspiration (TA) in patients with ST-segment elevation myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) remain controversial.

EVIDENCE ACQUISITION

Twenty-five eligible randomized controlled trials were included to compare the use of TA with PCI and PCI-only for STEMI. The primary endpoint was major adverse cardiac events (MACE) according to study definitions. The secondary endpoints were all-cause mortality, recurrent myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST) and stroke.

EVIDENCE SYNTHESIS

In comparison with conventional PCI, TA followed by PCI was associated with a lower risk for MACE with statistical significance [relative risk (RR): 0.91; 95% confidence interval (CI): 0.83-0.99; P=0.04). Regarding secondary endpoints, there was a significant increase in the risk for stroke (RR: 1.56; 95% CI: 1.09-2.24; P=0.015); there were no differences in the risk of all-cause mortality (RR: 0.88; 95% CI: 0.78-1.01; P=0.06), myocardial infarction (RR: 0.94; 95% CI: 0.79-1.13; P=0.537), target vessel revascularization (RR: 0.92; 95% CI: 0.82-1.04; P=0.177), and definite or probable stent thrombosis (RR: 0.84; 95% CI: 0.66-1.07; P=0.151).

CONCLUSIONS

Updated data about routine TA-assisted PCI in STEMI showed reduced risk of subsequent MACE in comparison with conventional primary PCI, but get limited benefits related to the clinical endpoints, and may be associated with an increase in the risk of stroke. As a routine strategy, TA in patients with STEMI cannot be supported.