Role of Aspiration and Mechanical Thrombectomy in Patients With Acute Myocardial Infarction Undergoing PrimaryAngioplasty

Results T he weighted mean duration of clinical follow-up was 6 months. Aspiration thrombectomy vs. conventional primary PCI (18 trials, n1⁄43,936): Major adverse cardiac events (MACE) (risk ratio [RR]: 0.76; 95% confidence interval [CI]: 0.63 to 0.92; p 1⁄4 0.006) and all-cause mortality (RR: 0.71; 95% CI: 0.51 to 0.99; p 1⁄4 0.049) were significantly reduced with aspiration thrombectomy. Beneficial trends were noted for recurrent MI (p 1⁄4 0.11) and target vessel revascularization (p1⁄4 0.06). Final infarct size (p1⁄4 0.64) and ejection fraction (p1⁄4 0.32) at 1 month were similar. STsegment resolution (STR) at 60 min (RR: 1.31; 95% CI: 1.16 to 1.48; p < 0.0001) and Thrombolysis In Myocardial Infarction blush grade (TBG) 3 post-procedure (RR: 1.37; 95% CI: 1.19 to 1.59; p < 0.0001) were both improved with aspiration thrombectomy. Mechanical thrombectomy vs. conventional primary PCI (7 trials, n 1⁄4 1,598): there was no difference between the mechanical thrombectomy and conventional primary PCI arms in the incidence of MACE (RR: 1.10; 95% CI: 0.59 to 2.05; p 1⁄4 0.77), mortality (p 1⁄4 0.57), recurrent MI (p 1⁄4 0.32), target vessel revascularization (p 1⁄4 0.19), or final infarct size (p 1⁄4 0.47). A benefit in STR at 60 min (RR: 1.25; 95% CI: 1.06 to 1.47; p 1⁄4 0.007), but not TBG 3 (RR: 1.09; 95% CI: 0.86 to 1.38; p 1⁄4 0.48) was noted.