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Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials

Open access
Burzotta, F., De Vita, M., Gu, Y. L., Isshiki, T., Lefevre, T., Kaltoft, A., Dudek, D., Sardella, G., Orrego, P. S., Antoniucci, D., De Luca, L., Biondi-Zoccai, G. G.L., Crea, F., Zijlstra, F.·2009·European Heart Journal

Abstract

AIMS: Thrombectomy in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is associated to better myocardial reperfusion. However, no single trial was adequately powered to asses the impact of thrombectomy on long-term clinical outcome and to identify patients at higher benefit. Thus, we sought to assess these issues in a collaborative individual patient-data pooled analysis of randomized studies (study acronym: ATTEMPT, number of registration: NCT00766740). METHODS AND RESULTS: Individual data of 2686 patients enrolled in 11 trials entered the pooled analysis. Primary endpoint of the study was all-cause mortality. Major adverse cardiac events (MACE) were considered as the occurrence of all-cause death and/or target lesion/vessel revascularization and/or myocardial infarction (MI). Subgroups analysis was planned according to type of thrombectomy device (manual or non-manual), diabetic status, IIb/IIIa-inhibitor therapy, ischaemic time, infarct-related artery, pre-PCI TIMI flow. Clinical follow-up was available in 2674 (99.6%) patients at a median of 365 days. Kaplan-Meier analysis showed that allocation to thrombectomy was associated with significantly lower all-cause mortality (P = 0.049). Thrombectomy was also associated with significantly reduced MACE (P = 0.011) and death + MI rate during the follow-up (P = 0.015). Subgroups analysis showed that thrombectomy is associated to improved survival in patients treated with IIb/IIIa-inhibitors (P = 0.045) and that the survival benefit is confined to patients treated in manual thrombectomy trials (P = 0.011). CONCLUSION: The present large pooled analysis of randomized trials suggests that thrombectomy (in particular manual thrombectomy) significantly improves the clinical outcome in patients with STEMI undergoing mechanical reperfusion and that its effect may be additional to that of IIb/IIIa-inhibitors.

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Metadata

Authors
Burzotta, F., De Vita, M., Gu, Y. L., Isshiki, T., Lefevre, T., Kaltoft, A., Dudek, D., Sardella, G., Orrego, P. S., Antoniucci, D., De Luca, L., Biondi-Zoccai, G. G. L., Crea, F., & Zijlstra, F.
Venue
European Heart Journal
Published
2009-09-02
Volume
30
Issue
18
Pages
2193-2203
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
OpenAlex
W2086359359
Cited by
263
References
25
FWCI
19.97
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. https://app.cochat.ai/papers/10.1093/eurheartj/ehp348
The paper
Burzotta, F., De Vita, M., Gu, Y. L., Isshiki, T., Lefevre, T., Kaltoft, A., Dudek, D., Sardella, G., Orrego, P. S., Antoniucci, D., De Luca, L., Biondi-Zoccai, G. G. L., Crea, F., & Zijlstra, F. (2009). Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. European Heart Journal. https://doi.org/10.1093/eurheartj/ehp348

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.