Individual patient-data meta-analysis comparing clinical outcome in patients with ST-elevation myocardial  nfarction treated with percutaneous coronary intervention with or without prior thrombectomy. ATTEMPT study: A pooled Analysis of Trials on ThrombEctomy in acute Myocardial infarction based on individual PatienT data

Maria De Vita¹, Francesco Burzotta¹, Giuseppe GL Biondi-Zoccai², Thierry Lefevre³, Dariusz Dudek⁴, et al

¹Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy; ²Interventional Cardiology, University of Turin, Italy; ³ICPS, Massy, France; ⁴Department of Cardiology, Jagiellonian University, Kracow, Poland, et al

Background: Available data from randomized trials on thrombectomy in patients with ST-elevation myocardial infarction (STEMI) have shown favorable trends in myocardial reperfusion. However, few data are available on the effect of thrombectomy on clinical outcome. Thus we have designed a collaborative individual patient-data meta-analysis which aimed to assess the long-term clinical outcome in STEMI patients randomized to percutaneous coronary intervention (PCI) with or without thrombectomy.

Method: After a thorough database search, the principal investigators of randomized trials comparing thrombectomy with standard PCI in patients with STEMI were contacted. Principal investigators as authors of 11 randomized studies agreed to participate and were asked to complete a structured database by providing a series of key pre-PCI clinical and angiographic data as well as the longest available clinical outcome of the patients enrolled in the corresponding trial. The primary end-point of this pooled analysis is the comparison of overall survival rates between patients randomized to PCI with thrombectomy or PCI without thrombectomy. The secondary end-points are survival free from myocardial infarction (MI), target lesion revascularization (TLR), major adverse coronary events (MACE: death + MI + TLR) and death + MI between patients randomized to PCI with thrombectomy or PCI without thrombectomy. A pre-defined subgroup analysis is planned considering the following variables: type of thrombectomy device used, diabetes, rescue PCI, IIb/IIIa-inhibitors use, time-to-reperfusion, infarct-related artery, and pre-PCI TIMI flow.

Implications: This study will provide useful data on the effect of the reported improved myocardial perfusion associated with thrombectomy on the long-term clinical outcome in patients with STEMI.

Keywords: ST elevation myocardial infarction, thrombectomy, primary PCI