Author + information
- Konstantinos Marmagkiolis1,
- Konstantinos Charitakis2,
- Abdul Hakeem3,
- Mehmet Cilingiroglu4 and
- Dmitriy Feldman5
Recent randomized controlled trials (RCTs) have questioned the clinical efficacy and even safety of routine aspiration thrombectomy (AT) during primary PCI. A systematic synthesis of this randomized data is hence very timely to address this clinical equipoise.
We performed a meta-analysis of the larger (>150 patients) Randomized Controlled Trials (RCT) which compared aspiration thrombectomy with primary PCI alone. Our procedural end-points were Myocardial Blush Grade (MBG) of 0 or 1 and ST segment resolution(STR) of >50%. Mid-term end-points were mortality, reinfarction, target vessel revascularization and stroke >30 days after the procedure.
We identified 11 large RCTs with 10,309 patients randomized to AT and 10,296 to routine strategy (RT). While AT was associated with significantly improved myocardial perfusion as demonstrated by MBG score (OR:0.69 [0.49-1.41]; p=0.01), there was no difference in the rates of ST segment resolution > 50% (OR:1.06 [0.81-1.38]; p=0.81) between groups. In the 30 day outcomes there were no differences in mortality (OR:0.89 [0.76-1.05]; p=0.76), reinfarction (OR:0.9 [0.71-1.15]; p=0.47), TVR (OR:1.06 [0.81-1.38]; p=0.67) and stroke rates (OR:1.49 [0.86-2.58]; p=0.29).
Our meta-analysis of 20,605 patients who participated in large RCTs demonstrate improved MBG scores with aspiration thrombectomy compared to PCI alone, but no differences in STR >50%, mortality, reinfarction, TVR and stroke rates at 30 days. Our study supports the latest ACC/AHA/SCAI focused update document to recommend against the routine use of aspiration thrombectomy during primary PCI.