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Adjunctive Devices for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Slide: 27 of 39

Adjunctive Mechanical Thrombectomy Devices Versus PCI Alone in Patients With STEMI: All Outcomes and Adverse Events

In RCTs, the use of mechanical thrombectomy devices did not significantly impact mortality, MI, stroke, target revascularization, or MACE versus a control with the longest duration of followup. When the clinical trials eligible for pooling were evaluated at different time periods, target revascularization and MACE were significantly reduced at 180 days and 365 days (one trial), respectively, but no other significant effects were seen for these or other final health outcomes at other time periods. However, the strength of evidence was determined to be insufficient to make definitive conclusions regarding all final health outcomes for mechanical thrombectomy devices versus PCI alone in patients with STEMI. In RCTs, the use of mechanical thrombectomy devices did not significantly impact ST-segment resolution, ejection fraction, MBG-3, TIMI-3 blood flow, distal embolization, or no reflow versus a control. In a single controlled observational study, the use of a mechanical thrombectomy device was associated with a significantly reduced rate of TIMI-3 blood flow versus a control.

In RCTs, the use of mechanical thrombectomy devices versus control did not significantly impact the risk of coronary dissection, coronary perforation, or side branch occlusion. Three trials evaluated the impact of mechanical thrombectomy devices versus a control on procedure time although were ineligible for pooling. In all three trials, the procedure time was significantly prolonged in the mechanical thrombectomy device group versus a control group.