Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials
Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery...
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| Veröffentlicht in: | International journal of cardiology 2024-02, Vol.397, p.131590-131590, Article 131590 |
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| container_title | International journal of cardiology |
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| creator | Bianchini, Emiliano Lombardi, Marco Buonpane, Angela Ricchiuto, Alfredo Maino, Alessandro Laborante, Renzo Anastasia, Gianluca D'Amario, Domenico Aurigemma, Cristina Romagnoli, Enrico Leone, Antonio Maria D'Ascenzo, Fabrizio Trani, Carlo Crea, Filippo Porto, Italo Burzotta, Francesco Vergallo, Rocco |
| description | Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI).
PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA.
A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p |
| doi_str_mv | 10.1016/j.ijcard.2023.131590 |
| format | Article |
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PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA.
A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04).
TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2023.131590</identifier><identifier>PMID: 37979785</identifier><language>eng</language><publisher>Netherlands</publisher><subject>Humans ; Percutaneous Coronary Intervention - adverse effects ; Randomized Controlled Trials as Topic ; ST Elevation Myocardial Infarction - diagnostic imaging ; ST Elevation Myocardial Infarction - etiology ; ST Elevation Myocardial Infarction - surgery ; Thrombosis - etiology ; Treatment Outcome ; Ventricular Function, Left ; Ventricular Remodeling</subject><ispartof>International journal of cardiology, 2024-02, Vol.397, p.131590-131590, Article 131590</ispartof><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c307t-3c3b48c54e103a87c88fc5f5b1a141a7f77185061d66060fc0ffab56be162d3d3</citedby><cites>FETCH-LOGICAL-c307t-3c3b48c54e103a87c88fc5f5b1a141a7f77185061d66060fc0ffab56be162d3d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37979785$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bianchini, Emiliano</creatorcontrib><creatorcontrib>Lombardi, Marco</creatorcontrib><creatorcontrib>Buonpane, Angela</creatorcontrib><creatorcontrib>Ricchiuto, Alfredo</creatorcontrib><creatorcontrib>Maino, Alessandro</creatorcontrib><creatorcontrib>Laborante, Renzo</creatorcontrib><creatorcontrib>Anastasia, Gianluca</creatorcontrib><creatorcontrib>D'Amario, Domenico</creatorcontrib><creatorcontrib>Aurigemma, Cristina</creatorcontrib><creatorcontrib>Romagnoli, Enrico</creatorcontrib><creatorcontrib>Leone, Antonio Maria</creatorcontrib><creatorcontrib>D'Ascenzo, Fabrizio</creatorcontrib><creatorcontrib>Trani, Carlo</creatorcontrib><creatorcontrib>Crea, Filippo</creatorcontrib><creatorcontrib>Porto, Italo</creatorcontrib><creatorcontrib>Burzotta, Francesco</creatorcontrib><creatorcontrib>Vergallo, Rocco</creatorcontrib><title>Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI).
PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA.
A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04).
TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.</description><subject>Humans</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Randomized Controlled Trials as Topic</subject><subject>ST Elevation Myocardial Infarction - diagnostic imaging</subject><subject>ST Elevation Myocardial Infarction - etiology</subject><subject>ST Elevation Myocardial Infarction - surgery</subject><subject>Thrombosis - etiology</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Remodeling</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9UdFuFSEQJUZjb6t_YAyPvuwVlmVhfWsatU2a-GB9JrMstNzAsgJbc_0wv09utxpIZjI558zJHITeUbKnhPYfD3t30JCmfUtatqeM8oG8QDsqRddQwbuXaFdhouGtYGfoPOcDIaQbBvkanTEx1Cf5Dv25CQvogqPF5SHFMK4ZQ15cguLijOv3xhb8aOaSnF49JJxMiJPxbr7HME_YrrN-wroZL5VVkRn_cuUBf79rsrkPdYCNN4-bYjjGk2sHvhIspCfuJ3yJgynQwAz-mF0--UlVPQb320xYx7o-el_bagN8foNe2VrM2-d6gX58-Xx3dd3cfvt6c3V522hGRGmYZmMnNe8MJQyk0FJazS0fKdCOgrBCUMlJT6e-Jz2xmlgLI-9HQ_t2YhO7QB823SXFn6vJRQWXtfEeZhPXrFo51Fuzng0V2m1QnWLOyVi1JBcgHRUl6pSYOqgtMXVKTG2JVdr75w3rGMz0n_QvIvYXAvuZTA</recordid><startdate>20240215</startdate><enddate>20240215</enddate><creator>Bianchini, Emiliano</creator><creator>Lombardi, Marco</creator><creator>Buonpane, Angela</creator><creator>Ricchiuto, Alfredo</creator><creator>Maino, Alessandro</creator><creator>Laborante, Renzo</creator><creator>Anastasia, Gianluca</creator><creator>D'Amario, Domenico</creator><creator>Aurigemma, Cristina</creator><creator>Romagnoli, Enrico</creator><creator>Leone, Antonio Maria</creator><creator>D'Ascenzo, Fabrizio</creator><creator>Trani, Carlo</creator><creator>Crea, Filippo</creator><creator>Porto, Italo</creator><creator>Burzotta, Francesco</creator><creator>Vergallo, Rocco</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240215</creationdate><title>Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials</title><author>Bianchini, Emiliano ; Lombardi, Marco ; Buonpane, Angela ; Ricchiuto, Alfredo ; Maino, Alessandro ; Laborante, Renzo ; Anastasia, Gianluca ; D'Amario, Domenico ; Aurigemma, Cristina ; Romagnoli, Enrico ; Leone, Antonio Maria ; D'Ascenzo, Fabrizio ; Trani, Carlo ; Crea, Filippo ; Porto, Italo ; Burzotta, Francesco ; Vergallo, Rocco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-3c3b48c54e103a87c88fc5f5b1a141a7f77185061d66060fc0ffab56be162d3d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Humans</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Randomized Controlled Trials as Topic</topic><topic>ST Elevation Myocardial Infarction - diagnostic imaging</topic><topic>ST Elevation Myocardial Infarction - etiology</topic><topic>ST Elevation Myocardial Infarction - surgery</topic><topic>Thrombosis - etiology</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Remodeling</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bianchini, Emiliano</creatorcontrib><creatorcontrib>Lombardi, Marco</creatorcontrib><creatorcontrib>Buonpane, Angela</creatorcontrib><creatorcontrib>Ricchiuto, Alfredo</creatorcontrib><creatorcontrib>Maino, Alessandro</creatorcontrib><creatorcontrib>Laborante, Renzo</creatorcontrib><creatorcontrib>Anastasia, Gianluca</creatorcontrib><creatorcontrib>D'Amario, Domenico</creatorcontrib><creatorcontrib>Aurigemma, Cristina</creatorcontrib><creatorcontrib>Romagnoli, Enrico</creatorcontrib><creatorcontrib>Leone, Antonio Maria</creatorcontrib><creatorcontrib>D'Ascenzo, Fabrizio</creatorcontrib><creatorcontrib>Trani, Carlo</creatorcontrib><creatorcontrib>Crea, Filippo</creatorcontrib><creatorcontrib>Porto, Italo</creatorcontrib><creatorcontrib>Burzotta, Francesco</creatorcontrib><creatorcontrib>Vergallo, Rocco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bianchini, Emiliano</au><au>Lombardi, Marco</au><au>Buonpane, Angela</au><au>Ricchiuto, Alfredo</au><au>Maino, Alessandro</au><au>Laborante, Renzo</au><au>Anastasia, Gianluca</au><au>D'Amario, Domenico</au><au>Aurigemma, Cristina</au><au>Romagnoli, Enrico</au><au>Leone, Antonio Maria</au><au>D'Ascenzo, Fabrizio</au><au>Trani, Carlo</au><au>Crea, Filippo</au><au>Porto, Italo</au><au>Burzotta, Francesco</au><au>Vergallo, Rocco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2024-02-15</date><risdate>2024</risdate><volume>397</volume><spage>131590</spage><epage>131590</epage><pages>131590-131590</pages><artnum>131590</artnum><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI).
PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA.
A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04).
TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.</abstract><cop>Netherlands</cop><pmid>37979785</pmid><doi>10.1016/j.ijcard.2023.131590</doi><tpages>1</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Humans Percutaneous Coronary Intervention - adverse effects Randomized Controlled Trials as Topic ST Elevation Myocardial Infarction - diagnostic imaging ST Elevation Myocardial Infarction - etiology ST Elevation Myocardial Infarction - surgery Thrombosis - etiology Treatment Outcome Ventricular Function, Left Ventricular Remodeling |
| title | Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials |
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