Meta-analysis Of Thrombus Aspiration With PCI And PCI Alone In The Treatment Of Acute ST Elevation Myocardial Infarction

Objective: To evaluate the curative effect of thrombus aspiration with PCI during ST-segment elevation of acute myocardial infarction.Methods: Literature search key words: Acute myocardial infarction, Thrombus aspiration, etc. Searching the literature in Pubmed, CNKI, Wanfang about comparison between the thrombus aspiration with PCI and the PCI alone in January 2005- March2016. Two researchers respectively selected the literature according to inclusion and exclusion criteria, and then extracted information with cross check. An agreement could be reached through discussion between two researchers or consulting the third researcher in case of disagreement. The quality of literature was evaluated by using the jadad scale. Meta-analysis and systematic review were performed by Rev Man 5.3software.Results: A total of 14 RCTs were included in the study. In total, 22527 patients with acute myocardial infarction underwent randomization. There were 11179 in the groups of thrombus aspiration with PCI and 11348 in PCI alone. The jadad scale of the literature is from 4 to 6, and all the RCTs are of high quality. The results are as follows:1) All-cause mortality: There were 12 RCTs included with 22138 patients, 10982 in thrombus aspiration with PCI and 11156 in PCI alone, there was no significant difference between the two groups(RR=0.93, 95%CI=0.83(1.03, P=0.16). 2) The major adverse cardiovascular events: A total of 11 studies were included with 22016 patients10924 in thrombus aspiration with PCI, 11092 PCI alone. there was no significant difference between the two groups(RR=0.94,95%CI=0.87(1.01, P=0.10). 3) The postoperative TIMI 3 grade: 5 studies were included with 2024 patients, 943 in thrombus aspiration with PCI, 1081 in PCI alone group, the incidence of postoperative TIMI 3 grade in thrombus aspiration with PCI was higher than that of PCI alone.(RR=1.52, 95%CI=1.19(1.94, P=0.00008). 4) The postoperative MBG 3 grade: 3studies were included with 705 patients, 356 in thrombus aspiration with PCI, 349 in PCI alone, the incidence of postoperative MBG 3 grade in thrombus aspiration with PCI was higher than PCI alone(RR=1.78, 95%CI=1.24(2.56, P=0.002). 5) The no reflow /slow reflow post-procedurally: 5 studies were included with 1161 patients, 511 in thrombus aspiration with PCI, 650 in PCI alone, the incidence of no reflow/slow reflow after operation was lower in thrombus aspiration with PCI that in PCI alone(RR=0.50,95%CI=0.35~0.70,P<0.0001). 6) LVEF one month postoperatively: a total of 3 studies were included with 761 patients, 380 in thrombus aspiration with PCI, 381 in PCI alone; there was no significant difference of LVEF between the two groups(SMD=-0.03, 95%CI=-0.17(0.12, P=0.72). 7) LVEF 3 month postoperatively: 2 studies were included with 226 patients, 115 in thrombus aspiration with PCI, 111 in PCI alone;there was no significant difference of LVEF between the two groups(SMD=-0.05,95%CI=-0.52 ~ 0.43, P=0.85). 8) left ventricular diastolic volume 3months postoperatively: 2 studies were included with 226 patients, 115 in thrombus aspiration with PCI, 111 in PCI alone; there was no significant difference of left ventricular diastolic volume 3 months postoperatively between the two groups(SMD=-0.11,95%CI=-0.64( 0.42, P=0.69). 9) The myocardial infarction area 3 months postoperatively: 2 studies were included with 226 patients, 115 in thrombus aspiration with PCI, 111 in PCI alone; there was no significant difference of myocardial infarction area 3 months postoperatively between the two groups(SMD=-0.02,95%CI=-0.28(0.24,P=0.88).Conclusion1. For the primary clinical endpoint events, the meta-analysis failed to confirm the thrombus aspiration with PCI can reduce all-cause mortality.2. The meta-analysis also failed to find out that the thrombus aspiration with PCI can reduce the incidence of major adverse cardiovascular events, and improve LVEF,left ventricular diastolic volume or myocardial infarction area at 1 month and 3 months postoperatively.3. Thrombus aspiration with PCI can reduce the incidence of no reflow/slow reflow, and increase the incidence of TIMI 3 grade and MBG 3 grade, postoperatively,suggesting that the thrombus aspiration with PCI can improve the level of myocardial perfusion.