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Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials

Bavry, Anthony A. ; Kumbhani, Dharam J. ; Bhatt, Deepak L.

European heart journal, 2008-12, Vol.29 (24), p.2989-3001 [Periódico revisado por pares]

England: Oxford University Press

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Título:
Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials
Autor: Bavry, Anthony A. ; Kumbhani, Dharam J. ; Bhatt, Deepak L.
Assuntos: Acute coronary syndrome ; Angioplasty, Balloon, Coronary - methods ; Angioplasty, Balloon, Coronary - mortality ; Cardiac Catheterization - methods ; Coronary Angiography ; Coronary Thrombosis - mortality ; Coronary Thrombosis - prevention & control ; Embolic protection ; Embolization, Therapeutic - methods ; Embolization, Therapeutic - mortality ; Endpoint Determination ; Female ; Humans ; Major adverse cardiac events ; Male ; Meta-analysis ; Middle Aged ; Mortality ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Myocardial Reperfusion - methods ; Randomized Controlled Trials as Topic ; ST-elevation myocardial infarction ; Survival Analysis ; Thrombectomy ; Thrombectomy - methods ; Thrombectomy - mortality ; Thrombus aspiration
É parte de: European heart journal, 2008-12, Vol.29 (24), p.2989-3001
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Descrição: Aims 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. Methods and results 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). Conclusion 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.
Editor: England: Oxford University Press
Idioma: Inglês

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Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials

Bavry, Anthony A. ; Kumbhani, Dharam J. ; Bhatt, Deepak L.

England: Oxford University Press

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