A Systematic Review and Meta-analysis of Randomized Trials of Manual Thrombectomy in ST elevation myocardial infarction Investigators: Ashraf Alazzoni, MD, FRCPC Aiman Alak, MD Sanjit Jolly, MD, FRCPC McMaster University Hamilton, Ontario, Canada

Disclosure Statement of Financial Interest Institutional Grants from Medtronic

Rationale Given the divergent findings of TASTE and TAPAS, we sought to perform an updated meta-analysis Clinical outcomes examined: Mortality, reinfarction, stent thrombosis, TVR, TLR and rehospitalization for CHF at longest available follow up

Methods A comprehensive systematic search strategy of MEDLINE, EMBASE, and Cochrane for all published studies up to February 1st 2014 was done. Inclusion criteria: (a) all randomized controlled trials that assessed the clinical utility of manual thrombectomy; (b) in patients presenting with STEMI only. Studies were excluded if they did not report clinical outcomes.

Titles and abstracts were screened for inclusion criteria independently by two authors. Full texts of the selected articles were screened in duplicate for inclusion in the review. The risk of bias of the included studies was assessed by the two independent review authors. Fixed Effects Odds ratios were calculated

The included studies enrolled a total of 11,197 STEMI patients randomized to PCI with or without manual aspiration thrombectomy.

Procedure characteristics data were collected. Direct stenting was performed more frequently in the thrombectomy group compared with the PCI only group (average of 68.4% vs. 30% respectively).

All-Cause Death OR 0.82 (95% CI 0.55-1.01); P 0.06

Re-Infarction OR 0.61 (95% CI 0.42-0.88); P 0.008

Stroke OR 1.08 (95% CI 0.62-1.87); P 0.8

Stent thrombosis OR 0.54 (95% CI 0.32-0.93); P 0.03

TLR OR 0.67 (95% CI 0.5-0.91); P 0.01

TVR OR 0.85 (95% CI 0.68-1.08); P 0.18

Rehospitalisation for heart failure OR 0.25 (95% CI 0.09-0.71); P 0.009

Only two large trials, remaining small trials Limitations Only two large trials, remaining small trials No heterogeneity found based on I 2 testing Suggest cautious interpretation of meta-analyses based on small trials

Conclusion Manual Thrombectomy was not associated with a statistically significant reduction in mortality Thrombectomy was associated with reductions in other important outcomes such as stent thrombosis and recurrent MI The TOTAL trial (N=11,000) will provide important information regarding the benefit of manual thrombectomy in STEMI

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