Meta-analysis: The impact of thrombectomy during PCI (percutaneous coronary intervention) on mortality, re-infarction and target vessel revascularization among patients with ST elevation myocardial infarction compared with standard PCI.

摘要

Primary Objective: To determine whether enhanced PCI will lower mortality in patients presented with acute STEMI (ST elevation myocardial infarction) 1 month and 6 to 12 months after the procedure.;Note: Enhanced PCI means manual thrombectomy, thrombus aspiration thrombectomy, or rhyolitic thrombectomy before coronary angioplasty.;Secondary Objectives: Re-Infarction rate after enhanced PCI versus standard PCI in the same timeframes above, 1 month and 6-12 months. - Target vessel revascularization (TVR) rate after enhanced PCI versus standard PCI in 1 month and 6-12 months.;Methods: Inclusion criteria for studies: Inclusion criteria for studies: Randomized clinical trials ST elevation myocardial infarction (STEMI) Enhanced PCI versus standard PCI with mortality, re-infarction, and/or target vessel revascularization rates were reported in 1 month and/or 6 to 12 months. English language Human The database resources used in the research for the suitable studies are: PubMed, Ovid Medline, and Cochrane library using the criteria above. After pooling data out of the suitable studies, the meta-analysis was conducted using "Comprehensive meta-analysis "software version 3.3.070, date 20 Nov 2014.;Results: 22 eligible randomized controlled trials were included in the analysis with a total of 22,199 patients. In terms of Mortality: The overall risk ratio is 0.90 (95% confidence interval of 0.79-1.02, p-value of 0.12), which tells us that the enhanced PCI lowers the mortality by 10% compared with the standard PCI in patients with STEMI. But since the confidence interval range includes risk ratio of 1 this means that there is no statistically significant difference in mortality risk among STEMI patients who undergone enhanced PCI and standard PCI. In terms of target vessel revascularization (TVR): The overall risk ratio is 0.90 (95% confidence interval of 0.80-1.02, p-value 0.09), which tells us that STEMI patients who undergone enhanced PCI procedure will have a 10% lower risk of repeating TVR procedure compared with the standard PCI. But since the confidence interval range includes risk ratio of 1 this means that the mean risk ratio could be 1, in other words this means that there is no statistically significant difference in the risk of repeating the target vessel revascularization between STEMI patients who undergone enhanced PCI versus standard PCI.;The overall risk ratio is 0.97 (95% confidence interval of 0.81-1.17, p=0.78), which tells us that the enhanced PCI lowers the risk of re-infarction by 3% compared with the standard PCI in patients with STEMI. But since the confidence interval range includes risk ratio of 1 this means that the mean risk ratio could be 1, so there is no statistically significant difference in the risk of re-infarction among STEMI patients whether they received enhanced PCI or standard PCI.;Conclusion: The meta-analysis showed that there is no statistically significant difference between enhanced PCI and standard PCI in terms of mortality, target vessel revascularization and re-infarction.