Aspiration Thrombectomy for Treatment of ST-segment Elevation Myocardial Infarction: a Meta-analysis of 26 Randomized Trials in 11 943 Patients

Aspiration Thrombectomy in Patients Undergoing Primary Angioplasty for ST Elevation Myocardial Infarction: An Updated Meta‐Analysis

“…) When the second part of the analysis was performed the following results were obtained: For 5 studies with follow up reported to a month the crude stroke rate was 0.61% (55/9041) in the AT arm and 0.39% (36/9032) in the PPCI arm. (RR: 1.49, 95%CI: 0.98–2.27, P = 0.06, I 2 :0%, 5 included studies) (Fig. A).…”

“…We initially pooled all data from all 7 studies to include the longest term follow up on each study. We subsequently separately pooled data from 5 studies with 1 month follow up and 3 studies with 6 months or longer follow up and analyzed them to yield 2 separate forest plots (Fig. A and B) .…”

“…1,2,3 The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial enrolled 7,244 participants from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR), and found no difference in mortality, rehospitalization, stent thrombosis, target-vessel revascularization, and stroke between patients randomized to AT and PPCI. 2,3 More recently the Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL), which included 10,732 patients also found no difference between 2 groups in terms of cardiovascular death, recurrent myocardial infarction, stent thrombosis, or target-vessel revascularization however; significantly higher number of patients in the AT arm suffered from stroke at 30 and 180 days follow up (0.7% vs 0.3%, P ¼ 0.02 and 1% vs 0.5%, P ¼ 0.002). 1 Multiple meta-analysis have been published on this topic [4][5][6][7] in the past including recent paper published by Spitzer et al 7 in 2015 included 11,943 patients, however their search for included studies were performed till September 2014.…”

Selective thrombus Aspiration in ST Elevation Myocardial Infarction is still alive

“…El que esta mejoría no se haya acompañado de un beneficio pronóstico en estudios más amplios puede ser hasta cierto punto lógico al pensar que la mortalidad depende de muchos más factores (clínicos, angiográficos, función ventricular, tiempo de isquemia, amplitud del área en riesgo, presencia de un flujo colateral antes de la intervención, revascularización completa, tipo de stent, medicación adyuvante a corto y largo plazo, prevención secundaria, etc.). La interrelación entre esos factores puede reducir de manera importante la influencia de la TAsp en la mortalidad global de pacientes con IAMCEST no seleccionados (9). Además de este hecho, las bajas tasas de eventos en los grandes estudios, que reflejan la mejoría en el pronós-tico de los pacientes con IAMCEST en la actualidad, hacen aún más difícil que una terapia o procedimiento consiga demostrar dicha reducción de mortalidad, requiriendo una muestra ingente de pacientes.…”

“…(10). La única duda que se ha generado en cuanto a su seguridad es la descripción de un pequeño aumento de la tasa de ictus (1% vs 0,5%; p=0,002) en el estudio TOTAL (2), discordante con estudios previos y con los metaanálisis más recientes (9). Hay que destacar que los mismos autores del estudio TOTAL dudan de este hallazgo y asumen que puede ser debido al azar (2).…”