Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials
Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials
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DOI：
10.1093/eurheartj/ehn421
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发表时间：
2008-12-01
影响因子：
39.3
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Bavry, Anthony A.;Kumbhani, Dharam J.;Bhatt, Deepak L.
辅助取栓和栓塞保护装置在急性心肌梗死中的应用已经得到了广泛的研究，尽管结果主要集中在再灌注的替代标志物上。因此，辅助装置对临床结果的影响尚不清楚。本研究旨在确定与单独经皮冠状动脉介入治疗（PCI）相比，在急性心肌梗死血运重建术中使用血栓切除或栓塞保护装置是否能降低死亡率。我们检索了Cochrane和Medline数据库，寻找将st段抬高急性心肌梗死患者随机分配到PCI前辅助装置与单独PCI相比的临床试验。器械分为导管吸栓、机械取栓和栓塞保护。共有30项研究，6415名患者符合我们的选择标准。在5个月的加权平均随访中，所有研究中辅助装置组的死亡率为3.2%，而单纯PCI组为3.7%（相对危险度为0.87；95%可信区间为0.67-1.13）。在血栓抽吸研究中，辅助装置组死亡率为2.7%，单独PCI组死亡率为4.4% (P = 0.018)；机械取栓组死亡率为5.3%，单独PCI组死亡率为2.8% (P = 0.050)；栓塞保护组死亡率为3.1%，单独PCI组死亡率为3.4% （P = 0.69）。与单纯PCI相比，急性心肌梗死期间导管血栓抽吸有利于降低死亡率。机械取栓似乎会增加死亡率，而栓塞保护似乎具有中性效果。
Adjunctive thrombectomy and embolic protection devices in acute myocardial infarction have been extensively studied, although outcomes have mainly focused on surrogate markers of reperfusion. Therefore, the effect of adjunctive devices on clinical outcomes is unknown. This study sought to determine whether the use of a thrombectomy or embolic protection device during revascularization for acute myocardial infarction reduces mortality compared with percutaneous coronary intervention (PCI) alone.The Cochrane and Medline databases were searched for clinical trials that randomized patients with ST-elevation acute myocardial infarction to an adjuvant device prior to PCI compared with PCI alone. Devices were grouped into catheter thrombus aspiration, mechanical thrombectomy, and embolic protection. There were a total of 30 studies with 6415 patients who met our selection criteria. Over a weighted mean follow-up of 5.0 months, the incidence of mortality among all studies was 3.2% for the adjunctive device group vs. 3.7% for PCI alone (relative risk, 0.87; 95% confidence interval, 0.67-1.13). Among thrombus aspiration studies, mortality was 2.7% for the adjunctive device group vs. 4.4% for PCI alone (P = 0.018), for mechanical thrombectomy, mortality was 5.3% for the adjunctive device group vs. 2.8% for PCI alone (P = 0.050), and for embolic protection, mortality was 3.1% for the adjunctive device group vs. 3.4% for PCI alone (P = 0.69).Catheter thrombus aspiration during acute myocardial infarction is beneficial in reducing mortality compared with PCI alone. Mechanical thrombectomy appears to increase mortality, whereas embolic protection appears to have a neutral effect.