Michael Barkagan1, Arie Steinvil1, Yakir Berchenko2, Ariel Finkelstein1, Gad Keren1, Shmuel Banai1, Amir Halkin3. 1. Department of Cardiology, Tel Aviv Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel. 3. Department of Cardiology, Tel Aviv Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: amirh@tlvmc.gov.il.
Abstract
BACKGROUND: The efficacy and safety of thrombectomy as an adjunct to primary percutaneous intervention (PCI) in the management of acute myocardial infarction (AMI) are debated. We performed a meta-analysis of randomized trials comparing primary PCI performed with versus without routine aspiration thrombectomy (AT). METHODS: A meta-analysis of randomized AT trials reporting clinical outcomes was done in accordance with the PRISMA guidelines. Trials reporting only non-clinical endpoints and those of technologies other than manual devices were excluded. The primary endpoint of this meta-analysis was mortality (either all-cause or cardiovascular). Secondary endpoints were reinfarction, stent thrombosis, and stroke. RESULTS: Seventeen randomized trials, involving 20,853 patients were included. Weighted mean follow-up was 9.3 ± 3.3 months. The rates of all-cause mortality (reported in 14 trials, n = 10,430) and cardiovascular mortality (reported in 6 trials, n = 11,810) did not differ significantly between patients treated with or without AT (4.6% vs. 5.3%, RR = 0.88 [95%CI = 0.75-1.04]; and, 3.0% vs. 3.7%, RR = 0.83 [95%CI = 0.68-1.01]; respectively). The rates of reinfarction and stent thrombosis were also similar in patients treated with versus those treated without AT (2.1% vs. 2.2%; RR = 0.96 [95%CI = 0.80-1.15]; and, 1.2% vs. 1.4%; RR = 0.84 [95%CI = 0.65-1.07], respectively). However, stroke rates were increased with AT (0.84% vs. 0.52%, RR = 1.56 [95%CI = 1.09-2.25]). CONCLUSIONS: Routine AT as an adjunct to primary PCI does not reduce the rates of death, reinfarction, or stent thrombosis, but is associated with increased stroke risk.
BACKGROUND: The efficacy and safety of thrombectomy as an adjunct to primary percutaneous intervention (PCI) in the management of acute myocardial infarction (AMI) are debated. We performed a meta-analysis of randomized trials comparing primary PCI performed with versus without routine aspiration thrombectomy (AT). METHODS: A meta-analysis of randomized AT trials reporting clinical outcomes was done in accordance with the PRISMA guidelines. Trials reporting only non-clinical endpoints and those of technologies other than manual devices were excluded. The primary endpoint of this meta-analysis was mortality (either all-cause or cardiovascular). Secondary endpoints were reinfarction, stent thrombosis, and stroke. RESULTS: Seventeen randomized trials, involving 20,853 patients were included. Weighted mean follow-up was 9.3 ± 3.3 months. The rates of all-cause mortality (reported in 14 trials, n = 10,430) and cardiovascular mortality (reported in 6 trials, n = 11,810) did not differ significantly between patients treated with or without AT (4.6% vs. 5.3%, RR = 0.88 [95%CI = 0.75-1.04]; and, 3.0% vs. 3.7%, RR = 0.83 [95%CI = 0.68-1.01]; respectively). The rates of reinfarction and stent thrombosis were also similar in patients treated with versus those treated without AT (2.1% vs. 2.2%; RR = 0.96 [95%CI = 0.80-1.15]; and, 1.2% vs. 1.4%; RR = 0.84 [95%CI = 0.65-1.07], respectively). However, stroke rates were increased with AT (0.84% vs. 0.52%, RR = 1.56 [95%CI = 1.09-2.25]). CONCLUSIONS: Routine AT as an adjunct to primary PCI does not reduce the rates of death, reinfarction, or stent thrombosis, but is associated with increased stroke risk.
Authors: Regina El Dib; Frederick Alan Spencer; Erica Aranha Suzumura; Huda Gomaa; Joey Kwong; Gordon Henry Guyatt; Per Olav Vandvik Journal: BMC Cardiovasc Disord Date: 2016-06-02 Impact factor: 2.298
Authors: Hélder Pereira; Daniel Caldeira; Rui Campante Teles; Marco Costa; Pedro Canas da Silva; Vasco da Gama Ribeiro; Vítor Brandão; Dinis Martins; Fernando Matias; Francisco Pereira-Machado; José Baptista; Pedro Farto E Abreu; Ricardo Santos; António Drummond; Henrique Cyrne de Carvalho; João Calisto; João Carlos Silva; João Luís Pipa; Jorge Marques; Paulino Sousa; Renato Fernandes; Rui Cruz Ferreira; Sousa Ramos; Eduardo Infante Oliveira; Manuel de Sousa Almeida Journal: BMC Cardiovasc Disord Date: 2018-04-24 Impact factor: 2.298