Routine Manual Thrombus Aspiration in ST Elevation Myocardial Infarction: End of the TASTE after TOTALity of Data

Yıl 2017, Cilt: 20 Sayı: 2, 130 - 136, 01.08.2017

Selim Topcu

Öz

Introduction:
We
aimed to update our meta-analysis that investigated the effects of routine
manual thrombus aspiration (TA) on clinical outcomes in patients with ST
elevation myocardial infarction by publishing an additional large randomized
clinical trial.

Patients
and Metods: Sixteen studies in which primary percutaneous coronary
intervention [(PPCI) (n= 10.440) vs. TA + PPCI (n= 10.434)] was performed were
included to this meta-analysis. We calculated the risk ratio (RR) for clinical
outcome, such as all cause death, recurrent infarction (Re-MI), target vessel
revascularization/target lesion revascularization (TVR/TLR), stent thrombosis
(ST), and stroke. In addition, we performed trial sequential analysis (TSA) to
differentiate conclusive vs inconclusive results and to demonstrate the presence
or absence of futility. Our assumptions for TSA included two-sided testing were
type 1 error= 5%, power= 80%, and 20% relative risk reduction (RRR).

Results: There
were no significant differences between TA + PPCI and PPCI alone arms in terms
of all cause mortality [4.9% vs. 5.5%, RR= 0.895, 95% confidence interval (CI):
0.797-1.005, p= 0.060], Re-MI (2.1% vs. 2.2%, RR= 0.958, 95% CI: 0.797–1.151,
p= 0.647), TVR/TLR (6.3% vs. 6.1%, RR= 1.030, 95% CI: 0.926-1.146, p= 0.586),
and ST (1.2% vs. 1.4%, RR= 0.911, 95% CI: 0.712-1.166, p= 0.459). However, TA
slightly increased the risk of stroke (0.8% vs. 0.5%, RR= 1.535, 95% CI:
1.003-2.351, p= 0.049). TSA indicates that sufficient evidence exists to draw a
firm conclusion regarding death, re-MI, and TVR/TLR. However, TSA showed a lack
of sufficient evidence that TA resulted in a reduction in the incidence of ST
or increased the risk of stroke.

Conclusion: This updated meta-analysis
including over 20.000 patients showed that routine manual TA did not reduce the
incidence of all cause mortality, re-MI, TVR/TLR, and ST. The risk of stroke
might be increased in TA.

Anahtar Kelimeler

Aspiration thrombectomy, ST segment elevation myocardial infarction, primary percutaneous coronary intervention, meta-analysis

ST Elevasyonlu Miyokart İnfarktüsünde Rutin Trombüs Aspirasyonunun Yeri

Öz

Giriş: Bu çalışmada, büyük bir randomize kontrollü klinik
çalışma yayınlanması nedeniyle, daha önce yayınladığımız ST elevasyonlu
miyokart infarktüsü olan hastalarda rutin trombüs aspirasyonunun (TA)
etkilerini inceleyen meta-analizimizi güncellemeyi amaçladık.

Hastalar ve Yöntem: Bu meta-analize primer perkütan
koroner girişim (PPKG) uygulanmış hastaların alındığı çalışmalar dahil edildi.
Tüm nedenlere bağlı ölüm, tekrarlayan infarktüs (Re-MI), hedef damar/lezyon
revaskülarizasyon (TVR/TLR), stent trombozu (ST) ve inme  gibi klinik sonuçlar için risk oranı (RR)
hesaplandı. Ayrıca  klinik sıralı analiz
uygulandı. Klinik sıralı analiz için varsayımlarımız: tip 1 hata = %5, güç =
%80 ve relatif risk azalması %20 idi.

Bulgular: TA + PPKG ve PPKG kolları arasında tüm nedenlere bağlı
ölüm (%4.9 vs. %5.5, RR= 0.895, %95 CI: 0.797-1.005, p= 0.060), Re-MI (%2.1 vs.
%2.2, RR= 0.958, %95 CI: 0.797-1.151, p= 0.647), TVR/TLR (%6.3 vs. %6.1, RR=
1.030, %95 CI: 0.926-1.146, p= 0.586) ve ST (%1.2 vs. %1.4, RR= 0.911, %95 CI:
0.712-1.166, p= 0.459) bakımından anlamlı fark yoktu. Bununla beraber TA’nın
inme riskini bir miktar artırdığı gözlendi (%0.8 vs. %0.5, RR= 1.535, %95 CI:
1.003-2.351, p= 0.049).

Sonuç: Yirmi binden fazla
hastanın dahil edildiği güncellenmiş bu meta-analiz rutin manual trombüs
aspirasyonunun tüm nedenlere bağlı ölüm, tekrarlayan infarktüs (Re-MI), hedef
damar/lezyon revaskülarizasyonu ve stent trombozunu azaltmadığını gösterdi.
Fakat trombüs aspirasyonu ile inme riski artıyor olabilir.

Anahtar Kelimeler

Aspirasyon trombektomi, ST elevasyonlu miyokart infarktüsü, primer perkütan koroner girişim, meta-analiz

Kaynakça

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