Abstract 15502: Thrombus Aspiration in Primary Percutaneous Coronary Intervention: An Updated Meta-analysis

Abstract

Background: During primary percutaneous coronary intervention (PPCI), routine thrombus aspiration has been proposed based on small trials that suggested improved clinical outcomes, but last trials had reported conflicting results. We aimed to access whether thrombus aspiration and PPCI is superior to PPCI alone on clinical outcomes in patients with ST-elevation myocardial infarction, based on last clinical data. Methods: PubMed, Embase and Cochrane databases were searched. We included studies that randomized patients with ST-elevation myocardial infarction to thrombus aspiration and PPCI versus PPCI alone, and excluded studies that did not have clinical outcomes and those in which mechanical thrombectomy was used. We calculated risk ratio with 95% confidence interval (CI) for all-cause mortality, reinfarction, target vessel revascularization, stent thrombosis and stroke. Results: Twenty randomized trials enrolling 21,368 patients were included. Of these, 10,661 were randomized to thrombus aspiration and PPCI, and the remaining 10,707 to PPCI only. The all-cause mortality was similar between the two groups (risk ratio [RR] = 0.88; 95% CI 0.77-1.01, p=0.07). Although reinfarction (RR = 0.96; 0.80-1.15, p=0.64), target vessel revascularization (RR 0.93; 0.83-1.07; p=0.26) and stent thrombosis (RR = 0.83; 0.65-1.07, p=0.15) were also similar between the two groups, there was an increase in rate of stroke in patients randomized to thrombus aspiration (RR = 1.52; 1.08-2.14; p=0.02). Conclusion: This meta-analysis that includes the largest trial to date showed that thrombus aspiration did not reduce mortality, reinfarction, target vessel revascularization or stent thrombosis, but was associated with a higher rate of stroke.