• Dharam J Kumbhani, Anthony A Bavry, Milind Y Desai, Sripal Bangalore, Robert A Byrne, Hani Jneid, and Deepak L Bhatt.
• Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
• Catheter Cardiovasc Interv. 2014 Nov 15; 84 (6): 973-7.

ObjectivesWe sought to update our meta-analysis on clinical outcomes with aspiration thrombectomy prior to primary percutaneous coronary intervention (PPCI) compared with conventional PPCI alone due to the availability of additional trial data.BackgroundThe clinical efficacy of adjunctive aspiration thrombectomy in ST-elevation myocardial infarction (STEMI) patients undergoing PPCI remains controversial. A recent large-scale randomized trial showed no benefit in terms of mortality at 30 days.MethodsClinical trials that randomized STEMI patients to aspiration thrombectomy prior to PPCI compared with conventional PPCI alone were included.ResultsA total of 11,321 patients from 20 randomized controlled trials were included. The composite major adverse cardiac event (MACE) endpoint was lower in the aspiration thrombectomy arm compared with conventional PPCI alone (risk ratio [RR] = 0.81, 95% CI 0.70-0.94; P = 0.006). Although all-cause mortality was similar between the adjunctive aspiration thrombectomy arm and PPCI arms (RR = 0.83, 95% CI 0.67-1.01; P = 0.06), late mortality (6-12 months) was significantly reduced (RR = 0.64; 95% CI 0.44-0.92; P = 0.016). Reinfarction (RR = 0.64, 95% CI 0.44-0.92; P = 0.017) and stent thrombosis (RR = 0.54; 95% CI 0.32-0.91; P = 0.021) were similarly lower. Differences in target vessel revascularization were of borderline significance (RR = 0.83, 95% CI 0.68-1.01; P = 0.06).ConclusionsOur meta-analysis including all randomized controlled trials on aspiration thrombectomy to date demonstrates a significant reduction in adverse clinical outcomes including stent thrombosis compared with conventional PCI alone.© 2014 Wiley Periodicals, Inc.

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