Anthony A. Bavry

Randomized clinical trials that examined long‐term clinical outcomes of routine aspiration thrombectomy prior to primary percutaneous coronary intervention (PCI) in patients with acute ST‐segment elevation myocardial infarction have yielded different results. We hypothesized that the routine use of manual thrombus aspiration prior to primary PCI lacks long‐term clinical benefits. Electronic databases were searched for randomized trials comparing routine aspiration thrombectomy and conventional PCI. We included only trials that reported clinical outcomes beyond 6 months. The primary outcome was all‐cause mortality, and the secondary outcomes included major adverse cardiovascular events, re‐infarction, cardiovascular mortality, and stent thrombosis (ST). A DerSimonian‐Laird model was used to construct the summary estimates risk ratio (RR). We retrieved 18 trials with 20 641 ST‐segment elevation myocardial infarction patients, of whom 10 331 patients underwent routine aspiration thrombectomy prior to primary PCI. At a mean follow‐up of 12 months, there was no significant decrease in the risk of all‐cause mortality (RR: 0.93, 95% confidence interval [CI]: 0.82‐1.05, P = 0.22), major adverse cardiac events (RR: 0.95, 95% CI: 0.87‐1.03, P = 0.18), re‐infarction (RR: 0.95, 95% CI: 0.80‐1.13, P = 0.59), cardiovascular mortality (RR: 0.80, 95% CI: 0.47‐1.36, P = 0.40), or ST (RR: 0.80, 95% CI: 0.63‐1.01, P = 0.06) with routine aspiration thrombectomy. Routine aspiration thrombectomy prior to primary PCI was not associated with a reduction in long‐term mortality or clinical outcomes. Future randomized trials are warranted to further evaluate the role of aspiration thrombectomy in select patients and coronary lesions.