• Charan Lanjewar, Sanjit Jolly, and Shamir R Mehta.
• Seth G.S. Medical College & KEM Hospital, Mumbai, India. charanlanjewar@hotmail.com
• Indian Heart J. 2009 Jul 1;61(4):335-40.

BackgroundThrombus removal using aspiration-thrombectomy (AT) may improve outcomes in Acute Myocardial Infarction (AMI). We performed a meta-analysis of randomized trials evaluating AT during primary Percutaneous Coronary Intervention (PCI) to determine its impact on mortality and morbidity.MethodsStudies were included if they were randomized trials evaluating AT versus control in patients with AMI undergoing primary-PCI. Databases were searched for eligible studies (1990-February 2008). Efficacy outcomes including death as a primary and composite of death, re-MI, stroke and repeat revascularization as a secondary outcome were evaluated at follow-up. Trials were combined using a fixed effects model and heterogeneity was evaluated.Results18 trials involving 3871 patients were included. At average follow up of 8.9 months, mortality was significantly reduced in favour of AT (2.9% vs. 4.2%, OR 0.70, CI 0.49-0.99, P=0.04). The secondary outcome of composite of death, MI or stroke at average follow up of 8.9 months was not significantly reduced (5.6% vs. 7.1%, P=0.08) while the secondary outcome of death, MI, stroke, TVR & bleeding was significantly reduced (11% vs. 13.6% OR 0.77, CI 0.63-0.99, P 0.01) in the AT group. Thrombectomy devices were associated with a higher rate of thrombolysis in myocardial infarction 3 flow (OR 1.42; CI 1.17-1.72), Myocardial Blush Grade 3 flow (2.01; 1.74-2.31) and ST resolution (2.40; 2.08-2.78). There was no significant heterogeneity in any of the outcomes.ConclusionsIn primary PCI, the addition of AT reduces both mortality and recurrent ischemic events at follow up. These benefits are associated with improved early infarct-related artery patency.

12 keywords...

hide…