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Meta-Analysis
. 2010 Feb 26:10:10.
doi: 10.1186/1471-2261-10-10.

Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: a meta-analysis of randomized controlled trials

Umesh U Tamhane  1 , Stanley Chetcuti, Irfan Hameed, P Michael Grossman, Mauro Moscucci, Hitinder S Gurm
Affiliations
Meta-Analysis

Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: a meta-analysis of randomized controlled trials

Umesh U Tamhane et al. BMC Cardiovasc Disord. .

Abstract

Background: Clinical trials comparing thrombectomy devices with conventional percutaneous coronary interventions (PCI) in patients with acute ST elevation myocardial infarction (STEMI) have produced conflicting results. The objective of our study was to systematically evaluate currently available data comparing thrombectomy followed by PCI with conventional PCI alone in patients with acute STEMI.

Methods: Seventeen randomized trials (n = 3,909 patients) of thrombectomy versus PCI were included in this meta-analysis. We calculated the summary odds ratios for mortality, stroke, post procedural myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) grade flow, and post procedural ST segment resolution (STR) using random-effects and fixed-effects models.

Results: There was no difference in risk of 30-day mortality (44/1914 vs. 50/1907, OR 0.84, 95% CI 0.54-1.29, P = 0.42) among patients randomized to thrombectomy, compared with conventional PCI. Thrombectomy was associated with a significantly greater likelihood of TIMI 3 flow (1616/1826 vs. 1533/1806, OR 1.41, P = 0.007), MBG 3 (730/1526 vs. 486/1513, OR 2.42, P < 0.001), STR (923/1500 vs. 715/1494, OR 2.30, P < 0.001), and with a higher risk of stroke (14/1403 vs. 3/1413, OR 2.88, 95% CI 1.06-7.85, P = 0.04). Outcomes differed significantly between different device classes with a trend towards lower mortality with manual aspiration thrombectomy (MAT) (21/949 vs.36/953, OR 0.59, 95% CI 0.35-1.01, P = 0.05), whereas mechanical devices showed a trend towards higher mortality (20/416 vs.10/418, OR 2.07, 95% CI 0.95-4.48, P = 0.07).

Conclusions: Thrombectomy devices appear to improve markers of myocardial perfusion in patients undergoing primary PCI, with no difference in overall 30-day mortality but an increased likelihood of stroke. The clinical benefits of thrombectomy appear to be influenced by the device type with a trend towards survival benefit with MAT and worsening outcome with mechanical devices.

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Figures

Figure 1
Figure 1
Flow diagram depicting the selection of studies included in the meta-analysis.
Figure 2
Figure 2
The Forest plot of odds ratios of 30-day mortality. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars = 95% CI.
Figure 3
Figure 3
The Forest plot of odds ratios of 30-day mortality for manual aspiration therapy (MAT), mechanical and vacuum devices. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars = 95% CI.
Figure 4
Figure 4
The Forest plot of odds ratios of post procedural MBG 0-1. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars = 95% CI.
Figure 5
Figure 5
The Forest plot of odds ratios of post procedural MBG 3. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars = 95% CI.
Figure 6
Figure 6
The Forest plot of odds ratios of post procedural TIMI 3 flow. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars = 95% CI.
Figure 7
Figure 7
The Forest plot of odds ratios of post procedural ST-segment resolution > 70%. Sizes of data markers are proportional to the weight of each study in the meta analysis. Horizontal bars = 95% CI.
Figure 8
Figure 8
Funnel plot for the endpoint of 30-day death.
Figure 9
Figure 9
Funnel plot for the endpoint of myocardial blush grade 3.
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