Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction

作者：Sanjit S. Jolly, Stefan Karl James, Vladimír Džavík, John A. Cairns, Karim D. Mahmoud, Felix Zijlstra, Salim Yusuf, Goran K. Olivecrona, Henrik Renlund, Peggy Gao, Bo Lagerqvist, Ashraf Alazzoni, Sasko A. Kedev, Goran R. Stankovic, Brandi Meeks, Ole Fröbert · 发表于：Circulation · 年份：2016 · DOI：10.1161/circulationaha.116.025371 · 被引用次数：317 · 研究领域：Acute Myocardial Infarction Research、Coronary Interventions and Diagnostics、Antiplatelet Therapy and Cardiovascular Diseases

BACKGROUND: Thrombus aspiration during percutaneous coronary intervention (PCI) for the treatment of ST-segment-elevation myocardial infarction (STEMI) has been widely used; however, recent trials have questioned its value and safety. In this meta-analysis, we, the trial investigators, aimed to pool the individual patient data from these trials to determine the benefits and risks of thrombus aspiration during PCI in patients with ST-segment-elevation myocardial infarction. METHODS: Included were large (n≥1000), randomized, controlled trials comparing manual thrombectomy and PCI alone in patients with ST-segment-elevation myocardial infarction. Individual patient data were provided by the leadership of each trial. The prespecified primary efficacy outcome was cardiovascular mortality within 30 days, and the primary safety outcome was stroke or transient ischemic attack within 30 days. RESULTS: The 3 eligible randomized trials (TAPAS [Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction], TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia], and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) enrolled 19 047 patients, of whom 18 306 underwent PCI and were included in the primary analysis. Cardiovascular death at 30 days occurred in 221 of 9155 patients (2.4%) randomized to thrombus aspiration and 262 of 9151 (2.9%) randomized to PCI alone (hazard ratio, 0.84; 9...