Efficacy and safety of thrombus aspiration in ST-segment elevation myocardial infarction: an updated systematic review and meta-analysis of randomised clinical trials
| Autor: | Maria Teresa Di Dio, Anna Corsini, Francesco Saia, Nevio Taglieri, Miriam Compagnone, Matteo Bruno, Claudio Rapezzi, Riccardo Narducci, Maria Letizia Bacchi Reggiani, Gabriele Ghetti, Diego Della Riva, Gianluca Lanati, Antonio Bruno |
|---|---|
| Přispěvatelé: | Taglieri, Nevio, Bacchi Reggiani, Maria Letizia, Ghetti, Gabriele, Saia, Francesco, Compagnone, Miriam, Lanati, Gianluca, Di Dio Maria teresa, Bruno, Antonio, Bruno, Matteo, Della Riva, Diego, Corsini, Anna, Narducci, Riccardo, Rapezzi, Claudio |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Percutaneous medicine.medical_treatment 030204 cardiovascular system & hematology Coronary Angiography Critical Care and Intensive Care Medicine NO Electrocardiography 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine primary percutaneous intervention medicine Clinical endpoint Humans ST segment cardiovascular diseases 030212 general & internal medicine Myocardial infarction Thrombus Stroke Randomized Controlled Trials as Topic Thrombectomy business.industry Coronary Thrombosis ST-segment elevation myocardial infarction outcome thrombus aspiration Percutaneous coronary intervention General Medicine Odds ratio medicine.disease Cardiology ST Elevation Myocardial Infarction Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal: Acute Cardiovascular Care. 8:24-38 |
| ISSN: | 2048-8734 2048-8726 |
| DOI: | 10.1177/2048872618795512 |
| Popis: | Background: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial. Methods: We performed a meta-analysis of 25 randomised controlled trials in which 21,740 ST-segment elevation myocardial infarction patients were randomly assigned to thrombus aspiration plus primary percutaneous coronary intervention or primary percutaneous coronary intervention. Study endpoints were: death, myocardial infarction, stent thrombosis and stroke. Results: On pooled analysis, the risk of death (4.3% vs. 4.8%, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.79–1.03; P=0.123), myocardial infarction (2.4% vs. 2.5%, OR 0.95, 95% CI 0.80–1.13; P=0.57) and stent thrombosis (1.3% vs. 1.6%, OR 0.80, 95% CI 0.63–1.01; P=0.066) was similar between thrombus aspiration plus primary percutaneous coronary intervention and primary percutaneous coronary intervention. The risk of stroke was higher in the thrombus aspiration plus primary percutaneous coronary intervention than the primary percutaneous coronary intervention group (0.84% vs. 0.59%, OR 1.401, 95% CI 1.004–1.954; P=0.047). However, on sensitivity analysis after removing the TOTAL trial, thrombus aspiration plus primary percutaneous coronary intervention was not associated with an increased risk of stroke (OR 1.01, 95% CI 0.58–1.78). The weak association between thrombus aspiration and stroke was also confirmed by the fact that the lower bound of the 95% CI was slightly below unity after removing either the study by Kaltoft or the ITTI trial. There was no interaction between the main study results and follow-up, evidence of coronary thrombus, or study sample size. Conclusions: In patients with ST-segment elevation myocardial infarction, thrombus aspiration plus primary percutaneous coronary intervention does not reduce the risk of death, myocardial infarction or stent thrombosis. Thrombus aspiration plus primary percutaneous coronary intervention is associated with an increased risk of stroke; however, this latter finding appears weak. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|