European Heart Journal Advance Access published online on September 23, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn421
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Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials
1 Department of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
2 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
3 VA Boston Healthcare System and Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
Received 29 April 2008; revised 21 July 2008; accepted 29 August 2008.
* Corresponding author. Tel: +1 617 525 9307, Fax: +1 617 732 7134, Email: dlbhattmd{at}alum.mit.edu
Aims: Adjunctive thrombectomy and embolic protection devices in acute myocardial infarction have been extensively studied, although outcomes have mainly focused on surrogate markers of reperfusion. Therefore, the effect of adjunctive devices on clinical outcomes is unknown. This study sought to determine whether the use of a thrombectomy or embolic protection device during revascularization for acute myocardial infarction reduces mortality compared with percutaneous coronary intervention (PCI) alone.
Methods and results: The Cochrane and Medline databases were searched for clinical trials that randomized patients with ST-elevation acute myocardial infarction to an adjuvant device prior to PCI compared with PCI alone. Devices were grouped into catheter thrombus aspiration, mechanical thrombectomy, and embolic protection. There were a total of 30 studies with 6415 patients who met our selection criteria. Over a weighted mean follow-up of 5.0 months, the incidence of mortality among all studies was 3.2% for the adjunctive device group vs. 3.7% for PCI alone (relative risk, 0.87; 95% confidence interval, 0.67–1.13). Among thrombus aspiration studies, mortality was 2.7% for the adjunctive device group vs. 4.4% for PCI alone (P = 0.018), for mechanical thrombectomy, mortality was 5.3% for the adjunctive device group vs. 2.8% for PCI alone (P = 0.050), and for embolic protection, mortality was 3.1% for the adjunctive device group vs. 3.4% for PCI alone (P = 0.69).
Conclusion: Catheter thrombus aspiration during acute myocardial infarction is beneficial in reducing mortality compared with PCI alone. Mechanical thrombectomy appears to increase mortality, whereas embolic protection appears to have a neutral effect.
Key Words: Acute coronary syndrome • ST-elevation myocardial infarction • Meta-analysis • Mortality • Major adverse cardiac events • Thrombectomy • Embolic protection • Thrombus aspiration
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