Routine Manual Thrombus Aspiration in ST Elevation Myocardial Infarction: End of the TASTE after TOTALity of Data
Keywords: Aspiration thrombectomy, ST segment elevation myocardial infarction, primary percutaneous coronary intervention, meta-analysis
Introduction: We aimed to update our meta-analysis that investigated the effects of routine manual thrombus aspiration (TA) on clinical outcomes in patients with ST elevation myocardial infarction by publishing an additional large randomized clinical trial. Patients and Metods: Sixteen studies in which primary percutaneous coronary intervention [(PPCI) (n= 10.440) vs. TA + PPCI (n= 10.434)] was performed were included to this meta-analysis. We calculated the risk ratio (RR) for clinical outcome, such as all cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke. In addition, we performed trial sequential analysis (TSA) to differentiate conclusive vs inconclusive results and to demonstrate the presence or absence of futility. Our assumptions for TSA included two-sided testing were type 1 error= 5%, power= 80%, and 20% relative risk reduction (RRR). Results: There were no significant differences between TA + PPCI and PPCI alone arms in terms of all cause mortality [4.9% vs. 5.5%, RR= 0.895, 95% confidence interval (CI): 0.797-1.005, p= 0.060], Re-MI (2.1% vs. 2.2%, RR= 0.958, 95% CI: 0.797-1.151, p= 0.647), TVR/TLR (6.3% vs. 6.1%, RR= 1.030, 95% CI: 0.926-1.146, p= 0.586), and ST (1.2% vs. 1.4%, RR= 0.911, 95% CI: 0.712-1.166, p= 0.459). However, TA slightly increased the risk of stroke (0.8% vs. 0.5%, RR= 1.535, 95% CI: 1.003-2.351, p= 0.049). TSA indicates that sufficient evidence exists to draw a firm conclusion regarding death, re-MI, and TVR/TLR. However, TSA showed a lack of sufficient evidence that TA resulted in a reduction in the incidence of ST or increased the risk of stroke. Conclusion: This updated meta-analysis including over 20.000 patients showed that routine manual TA did not reduce the incidence of all cause mortality, re-MI, TVR/TLR, and ST. The risk of stroke might be increased in TA.