Meta-Analysis of the Long-Term Effect of Routine Aspiration Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract American College of Cardiology Foundation/American Heart Association guidelines no longer recommend the use of routine aspiration thrombectomy during primary percutaneous coronary intervention (PCI). This is based on evidence from recent randomized controlled trials (RCTs) that suggests that the long-term benefits of aspiration thrombectomy were previously overestimated. We conducted a systematic review and meta-analysis of RCTs to examine the effect of routine aspiration thrombectomy during primary PCI versus primary PCI alone on markers of reperfusion immediately post-PCI and on clinical outcomes at ≥ 6 months. We systematically searched Medline, EMBASE, and the Cochrane Library of Clinical Trials for RCTs published in English or French with follow-up ≥ 6 months. Data were pooled using random-effects models. Eighteen publications (containing data from 14 RCTs, n=20,285) met our inclusion criteria. Aspiration thrombectomy was associated with higher rates of ST-segment resolution (relative risk [RR]: 1.22; 95% CI: 1.07, 1.40) and myocardial blush grade 3 (RR: 1.30; 95% CI: 1.01, 1.67), and a reduced risk of no reflow immediately post-PCI (RR: 0.63; 95% CI: 0.40, 0.98). However, thrombectomy was not associated with our primary outcome of all-cause mortality at longest available follow-up (RR: 0.92; 95% CI: 0.81, 1.04). Similar results were obtained for myocardial infarction (MI) and target vessel/lesion revascularization. Thrombectomy also increased the risk of stroke (RR: 1.59; 95% CI: 1.07, 2.35). In conclusion, routine aspiration thrombectomy during primary PCI has some short-term clinical benefits but does not improve outcomes ≥ 6 months and increases the risk of stroke.