Abstract
Objective Intracoronary (IC) glycoprotein IIb/IIIa inhibitors (GPIs) after thrombus aspiration (TA) for patients with ST-segment elevation myocardial infarction (STEMI), as compared with percutaneous coronary interventions (PCI) alone, is still on debate. To address this issue, we performed a meta-analysis of results from prospective or randomized controlled trials on the topic. Methods We searched electronic and printed sources (up to June 20, 2016) according to the selection criteria. Data were abstraction and meta-analysis was performed using RevMan 5.3 software. Results The cohorts involved 14 articles describing 1,918 participants were included. The incidence of the short-term major adverse cardiac events (MACE) was significantly reduced with intracoronary GPIs after TA (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.13 to 0.65, p=0.003). Benefits were noted for short-term mortality (OR: 0.31; 95% CI: 0.17 to 0.57, p=0.0002) and reinfarction (OR: 0.28; 95% CI: 0.10 to 0.78, p=0.01) in subjects who received intracoronary GPIs after TA. Moreover, the Thrombolysis in Myocardial Infarction (TIMI) trial grade 3 postprocedure (OR: 2.29; 95% CI: 1.72 to 3.04, P<0.00001) and complete ST-segment resolution (STR) rate (OR: 2.68; 95% CI: 1.85 to 3.87, P<0.00001) were both improved with intracoronary GPIs after TA. As a result, left ventricular ejection fraction (LVEF) at short-term follow-up showed a significant difference (OR: 7.33; 95% CI: 5.60 to 9.06, p<0.0001) in favor of the TA and intracoronary GPIs administration. Conclusions Our study demonstrates that intracoronary GPIs may have a synergistic effect with thrombus aspiration on short-term mortality, reinfarction, and cardiac functional recovery.
Highlights
Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion modality for patients with acute ST-segment elevation myocardial infarction (STEMI) [1]
Thrombus aspiration (TA): thrombus aspiration; OR: odds ratio; 95% CI: 95% confidence interval; Thrombolysis in Myocardial Infarction (TIMI): thrombolysis in myocardial infarction trial; major adverse cardiovascular events (MACE): major adverse cardiac events
(2) The incidence of short-term MACE was significantly reduced with intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) after thrombus aspiration, including death and reinfarction, whereas there was no trend towards better outcome in studies with long-term MACE
Summary
Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion modality for patients with acute ST-segment elevation myocardial infarction (STEMI) [1]. Even though numerous international studies have been reported, there are still conflicting results on the clinical impact of thrombus aspiration during primary PCI [3, 4]. Recent evidence from Routine Aspiration Thrombectomy With Percutaneous Coronary Intervention (PCI) Versus PCI Alone in Patients With ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary PCI (TOTAL) trial, the largest trial of thrombus aspiration in STEMI so far, suggested that routine thrombus aspiration, as compared with PCI alone, did not reduce the risk of major adverse cardiovascular events (MACE) within 180 days [5], consistent with those of Thrombus Aspiration during STSegment Elevation Myocardial Infarction (TASTE) trial [4] and the Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction. The reason for the discrepancy is unclear but may be related to low statistical power or difference among the ethnic groups studied
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