A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS OF MANUAL THROMBECTOMY IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Abstract

The utility of manual thrombectomy in patients with ST elevation myocardial infarction (STEMI) has been questioned after the recent publication of the TASTE (Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction) study (N=7244). This study was larger than all combined previous trials published to date and it found no benefit with manual thrombectomy for the primary outcome of all cause mortality. With these new findings, we sought to perform an updated meta-analysis of randomized clinical trials with a focus on clinical outcomes. Medline, Embase and Cochrane database as well as conference proceeding from major cardiology meetings were searched for randomized trials comparing manual aspiration thrombectomy in addition to percutaneous coronary intervention (PCI) versus PCI alone in patients presenting with STEMI. Data was extracted and articles were critically appraised by two authors. Fixed effects model was used with odds ratios (OR). A total of 19 randomized controlled trials enrolled 11,197 patients presenting with STEMI to either manual thrombectomy and PCI or conventional PCI. There was a non-significant trend toward reduction in all cause death with manual thrombectomy vs. PCI alone (2.9% vs. 3.5% with an odds ratio (OR) of 0.82 (95% CI: 0.66 to 1.01; p=0.06)). Manual thrombectomy was associated with a reduction in the incidence of re-infarction (OR: 0.61; 95% CI: 0.42 to 0.88; p=0.008), stent thrombosis (OR: 0.54; 95% CI: 0.32 to 0.93; p=0.02), target lesion revascularization (OR: 0.67; 95% CI: 0.5 to 0.91; p= 0.01) and rehospitalisation for heart failure (OR: 0.25; 95% CI: 0.09 to 0.71; p= 0.009). Manual thrombectomy was not associated with an increase in the risk of stroke (OR: 1.08; 95% CI: 0.62 to 1.87; p= 0.8). Manual thrombectomy reduced the incidence of myocardial re-infarction, stent thrombosis, target lesion revascularization and rehospitalisation for heart failure. Further large scale trials are needed to determine the effect of thrombectomy on mortality.