Researchers led by Stéphane Rinfret, MD, SM, of the Hôpital Laval Research Centre (Quebec City, Canada), identified 21 eligible trials including 4,299 patients with STEMI who were randomized to primary PCI with or without thrombectomy.
Sixteen of the trials (n = 3,365) evaluated manual thrombectomy.
In an e-mail communication, Dr. Rinfret
told TCTMD that while the meta-analysis produced findings that were not unexpected based on the bulk of evidence, it was valuable in that it includes new trial data.
The current paper adds 7 studies with 946 patients to previous analyses.
Importantly, "[o]ur meta-analysis is the first to demonstrate that thrombectomy prevents no reflow," he
said, proposing that this was likely due to a larger sample size.
In addition, Dr. Rinfret
said that the "lack of clinical impact is not that surprising, given the very low rates of adverse clinical outcomes, including death, in these trials.
, for his
part, said that based on the literature it would be reasonable to perform thrombectomy alongside primary PCI but only with the goal of preventing periprocedural complications such as embolization and no reflow, not to improve short-term clinical outcomes.
Thus, the technique "makes our life easier in the cath lab as interventional cardiologists, and this is an important consideration," he
However, Dr. Rinfret
similarly stressed that thrombectomy is "not likely to be helpful in the absence of overt thrombus.