PMID- 20187958
OWN - NLM
STAT- MEDLINE
DCOM- 20100914
LR  - 20240516
IS  - 1471-2261 (Electronic)
IS  - 1471-2261 (Linking)
VI  - 10
DP  - 2010 Feb 26
TI  - Safety and efficacy of thrombectomy in patients undergoing primary percutaneous 
      coronary intervention for acute ST elevation MI: a meta-analysis of randomized 
      controlled trials.
PG  - 10
LID - 10.1186/1471-2261-10-10 [doi]
AB  - BACKGROUND: Clinical trials comparing thrombectomy devices with conventional 
      percutaneous coronary interventions (PCI) in patients with acute ST elevation 
      myocardial infarction (STEMI) have produced conflicting results. The objective of 
      our study was to systematically evaluate currently available data comparing 
      thrombectomy followed by PCI with conventional PCI alone in patients with acute 
      STEMI. METHODS: Seventeen randomized trials (n = 3,909 patients) of thrombectomy 
      versus PCI were included in this meta-analysis. We calculated the summary odds 
      ratios for mortality, stroke, post procedural myocardial blush grade (MBG), 
      thrombolysis in myocardial infarction (TIMI) grade flow, and post procedural ST 
      segment resolution (STR) using random-effects and fixed-effects models. RESULTS: 
      There was no difference in risk of 30-day mortality (44/1914 vs. 50/1907, OR 
      0.84, 95% CI 0.54-1.29, P = 0.42) among patients randomized to thrombectomy, 
      compared with conventional PCI. Thrombectomy was associated with a significantly 
      greater likelihood of TIMI 3 flow (1616/1826 vs. 1533/1806, OR 1.41, P = 0.007), 
      MBG 3 (730/1526 vs. 486/1513, OR 2.42, P < 0.001), STR (923/1500 vs. 715/1494, OR 
      2.30, P < 0.001), and with a higher risk of stroke (14/1403 vs. 3/1413, OR 2.88, 
      95% CI 1.06-7.85, P = 0.04). Outcomes differed significantly between different 
      device classes with a trend towards lower mortality with manual aspiration 
      thrombectomy (MAT) (21/949 vs.36/953, OR 0.59, 95% CI 0.35-1.01, P = 0.05), 
      whereas mechanical devices showed a trend towards higher mortality (20/416 
      vs.10/418, OR 2.07, 95% CI 0.95-4.48, P = 0.07). CONCLUSIONS: Thrombectomy 
      devices appear to improve markers of myocardial perfusion in patients undergoing 
      primary PCI, with no difference in overall 30-day mortality but an increased 
      likelihood of stroke. The clinical benefits of thrombectomy appear to be 
      influenced by the device type with a trend towards survival benefit with MAT and 
      worsening outcome with mechanical devices.
FAU - Tamhane, Umesh U
AU  - Tamhane UU
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
FAU - Chetcuti, Stanley
AU  - Chetcuti S
FAU - Hameed, Irfan
AU  - Hameed I
FAU - Grossman, P Michael
AU  - Grossman PM
FAU - Moscucci, Mauro
AU  - Moscucci M
FAU - Gurm, Hitinder S
AU  - Gurm HS
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20100226
PL  - England
TA  - BMC Cardiovasc Disord
JT  - BMC cardiovascular disorders
JID - 100968539
SB  - IM
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*mortality/*therapy
MH  - *Randomized Controlled Trials as Topic
MH  - Stroke/etiology/mortality
MH  - Thrombectomy/*adverse effects
MH  - Thrombolytic Therapy/instrumentation
PMC - PMC2838805
EDAT- 2010/03/02 06:00
MHDA- 2010/09/15 06:00
PMCR- 2010/02/26
CRDT- 2010/03/02 06:00
PHST- 2009/03/10 00:00 [received]
PHST- 2010/02/26 00:00 [accepted]
PHST- 2010/03/02 06:00 [entrez]
PHST- 2010/03/02 06:00 [pubmed]
PHST- 2010/09/15 06:00 [medline]
PHST- 2010/02/26 00:00 [pmc-release]
AID - 1471-2261-10-10 [pii]
AID - 10.1186/1471-2261-10-10 [doi]
PST - epublish
SO  - BMC Cardiovasc Disord. 2010 Feb 26;10:10. doi: 10.1186/1471-2261-10-10.