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

Slide: 23 of 39

Adjunctive Catheter Aspiration Thrombectomy Versus PCI Alone in Patients With STEMI: Adverse Events

In RCTs eligible for pooling, the use of catheter aspiration devices versus a control significant reduced the risk of coronary dissection and did not significantly impact the risk of side branch occlusion. Given the risk difference for coronary dissection [RD -0.02 (-0.12, 0.10), (CER 0.0 to 0.1)], 50 people would need to be treated with a catheter aspiration device to prevent 1 person from experiencing a coronary dissection. In the one trial in which coronary perforation was assessed, no events occurred in either group. Nine trials evaluated procedure time although were ineligible for pooling. In eight of the nine trials, the use of catheter aspiration devices versus a control did not significantly prolong procedure time. One controlled observational study found no significant difference in procedure time between catheter aspiration and a control.

Two direct comparative randomized trials in patients with STEMI undergoing PCI evaluated adverse outcomes. One direct comparative randomized trial compared a catheter aspiration device to another catheter aspiration device. In this trial, the use of one catheter aspiration device versus another did not significantly impact the risk of coronary dissection. No patients experienced coronary perforation in either group. One direct comparative randomized trial compared a catheter aspiration device to a distal balloon embolic protection device. In this trial, the use of a catheter aspiration device did not impact procedure time when compared with a distal balloon embolic protection device. No direct comparative trials evaluated side branch occlusion.