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Efficacy and safety of routine thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: An updated systematic review and meta-analysis of randomized controlled trials
Efficacy and safety of routine thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: An updated systematic review and meta-analysis of randomized controlled trials
- Source :
- Catheterization and Cardiovascular Interventions. 87:650-660
- Publication Year :
- 2015
- Publisher :
- Wiley, 2015.
-
Abstract
- Background Randomized clinical trials evaluating the role of thrombus aspiration (TA) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) have yielded contrasting results. Therefore, the efficacy and safety of TA in STEMI is unclear. Objective We sought to evaluate the efficacy and safety of TA during PPCI for STEMI compared with conventional PPCI alone. Methods We included study-level data from 25 randomized, controlled trials, involving 21,733 patients with STEMI and PPCI. The primary efficacy endpoint was major adverse cardiac events (MACE) according to study definitions; the primary safety endpoint was stroke. Results The mean weighted follow-up time across studies was 8.2 months. Compared with conventional PPCI, TA was associated with significant lower risk for MACE [relative risk (RR): 0.91; 95% confidence interval (CI): 0.83–1.00; P = 0.042). However, this benefit in MACE was counterbalanced by a significant increase in the risk for stroke (RR: 1.58; 95% CI: 1.11–2.25; P = 0.011). There were no differences in the risk of myocardial infarction (RR: 0.94; 95% CI: 0.78–1.12; P = 0.486), target vessel revascularization (RR: 0.93; 95% CI: 0.82–1.04; P = 0.2), and definite or probable stent thrombosis (RR: 0.84; 95% CI: 0.66–1.07; P = 0.148). TA was associated with an ostensible lower risk for all-cause mortality, which did not reach statistical significance (RR: 0.88; 95% CI: 0.78–1.00; P = 0.059). Conclusions Compared with conventional PPCI for STEMI, adjunctive TA reduces the risk of subsequent MACE. However, the benefit in MACE is counterbalanced by an increased risk in stroke. Considering the above potential risks and benefits, TA should be considered in selected patients lesions rather than routinely. © 2015 Wiley Periodicals, Inc.
- Subjects :
- medicine.medical_specialty
Time Factors
medicine.medical_treatment
030204 cardiovascular system & hematology
Lower risk
Risk Assessment
law.invention
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Randomized controlled trial
Recurrence
Risk Factors
law
Internal medicine
Odds Ratio
Humans
Medicine
Radiology, Nuclear Medicine and imaging
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Stroke
Randomized Controlled Trials as Topic
Thrombectomy
business.industry
Coronary Thrombosis
Patient Selection
Percutaneous coronary intervention
General Medicine
Odds ratio
medicine.disease
Treatment Outcome
Relative risk
Cardiology
ST Elevation Myocardial Infarction
Cardiology and Cardiovascular Medicine
business
Mace
Subjects
Details
- ISSN :
- 15221946
- Volume :
- 87
- Database :
- OpenAIRE
- Journal :
- Catheterization and Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....c577c20a32efa69a900fb4d6ae7a5746
- Full Text :
- https://doi.org/10.1002/ccd.26152