Manual vs mechanical thrombectomy during PCI for STEMI: a comprehensive direct and adjusted indirect meta-analysis of randomized trials
Am J Cardiovasc Dis 2013;3(3):146-157
Eliano Pio Navarese, Giuseppe Tarantini, Giuseppe Musumeci, Massimo Napodano, Roberta Rossini, Mariusz Kowalewski, Anna Szczesniak, Michalina Kołodziejczak, Jacek Kubica
Thrombus removal by manual thrombectomy improves coronary flow and myocardial perfusion after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI); growing interest is on mechanical devices for thrombectomy which may allow a larger thrombus removal as compared to manual devices. We aimed to perform the first direct and adjusted indirect meta-analysis of studies on manual and mechanical thrombectomy in PCI for STEMI.
Methods: The literature was scanned for direct and indirect randomized comparisons between manual and/or mechanical thrombectomy and/or placebo by formal searches of electronic databases from November 1994 to June 2013. Clinical and procedural endpoints were selected.
Results: Three studies directly comparing (2 RCTs and 1 non-randomized; N = 513) and 21 RCTs (N = 4514) indirectly comparing the two strategies were included in the meta-analysis. The direct meta-analysis showed comparable rates of survival (p = 0.88), re-infarction (MI) (p = 0.84) and procedural outcomes between the two strategies; direct evidence was however limited in number of enrolled patients. The indirect meta-analysis showed a superior reduction in mortality with manual thrombectomy compared to mechanical thrombectomy in the overall analysis (p = 0.01); by excluding trials with low percentage of patients with intracoronary thrombus (< 50%) at baseline, the two strategies were comparable in survival, but mechanical thrombectomy was associated with a significant reduction in re-MI (p < 0.001) and stroke (p = 0.04).
Conclusions: This meta-analysis lends support to mechanical thrombectomy in the population with high thrombus burden only where, compared to manual thrombectomy, it is likely to provide higher benefits in reduction of re-MI and stroke.
Open access full text article: ajcd1306005