Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration

Jolly, SS; James, S; Džavík, V; Cairns, JA; Mahmoud, KD; Zijlstra, F; Yusuf, S; Olivecrona, GK; Renlund, H; Gao, P; Lagerqvist, B; Alazzoni, A; Kedev, S; Stankovic, G; Meeks, B; Frøbert, O

doi:10.1161/circulationaha.116.025371

Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration

CirculationPublished 9 Dec 2016Individual patient data meta-analysis of randomised controlled trials

Pooled result · CV deathResultHazard ratio 0.84 95% CI 0.70–1.01

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Authors' conclusion

Routine thrombus aspiration during PCI for ST-segment-elevation myocardial infarction did not improve clinical outcomes.

Study context

Population: Patients with STEMI undergoing percutaneous coronary intervention (PCI)
Participants: 19,047 patients · 3 RCTs

Comparison: Routine thrombus aspiration with PCI vs PCI alone
Thrombus aspirationn = 9,155
PCI alonen = 9,151reference
Outcome: CV mortality (primary efficacy); stroke or TIA (primary safety)
Follow-up: 30 days

Methodological detailsprespecified primary outcomes, 3 large RCTs (n≥1000): TAPAS, TASTE, TOTAL, Individual patient data provided by the leadership of each trial

Prespecified primary outcomes
3 large RCTs (n≥1000): TAPAS, TASTE, TOTAL
Individual patient data provided by the leadership of each trial

Pooled result

CV death

Hazard ratio

0.84

95% CI 0.70–1.01

P = 0.06

Events by group

Thrombus aspiration2.4%221 of 9155

PCI alone2.9%262 of 9151

Thrombus aspiration vs PCI alone

HR 0.84 (95% CI 0.70–1.01); P = 0.06

As reported in the abstract

Further pooled results

Outcome	Thrombus aspiration	PCI alone	← Lower risk with thrombus aspiration ←→ Higher risk with thrombus aspiration →	HR (95% CI)	P value
CV death, high thrombus burden (TIMI thrombus grade ≥3) (subgroup)	2.5%	3.1%	0.512	0.80 (0.65–0.98)	P = 0.03
			0.512Hazard ratio (log scale)

CV death, high thrombus burden (TIMI thrombus grade ≥3) (subgroup): interaction P=0.32

Recurrent MI, stent thrombosis, HF, target vessel revascularization

No significant differences

Safety

Outcome	Thrombus aspiration	PCI alone	← Lower odds with thrombus aspiration ←→ Higher odds with thrombus aspiration →	OR (95% CI)	P value
Stroke or TIA (primary safety outcome) · 30 days	0.8%	0.5%	0.512	1.43 (0.98–2.10)	P = 0.06
Stroke or TIA, high thrombus burden (TIMI thrombus grade ≥3) (subgroup)	0.9%	0.5%	0.512	1.56 (1.02–2.42)	P = 0.04
			0.512Odds ratio (log scale)

Stroke or TIA, high thrombus burden (TIMI thrombus grade ≥3) (subgroup): interaction P=0.34

Original publication

Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration. Circulation. Published 9 December 2016. doi:10.1161/circulationaha.116.025371

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Summarised from the published abstract; every number is checked against it