Research in context
Evidence before this study
We did a comprehensive systematic search of the MEDLINE, Embase, and Cochrane databases for randomised controlled trials that assessed the clinical utility of manual thrombectomy in patients presenting with ST elevation myocardial infarction (STEMI) only, published from any time up to Sept 3, 2015. We did not use any language restrictions in our search. Our search terms included “thrombectomy”, “thrombus aspiration”, “thromboaspiration”, “myocardial infarction”, “percutaneous coronary intervention”, and “randomized” (appendix p 10). We identified 669 abstracts, from which we selected 20 randomised trials (n=21 173) for inclusion. Our search showed that before the TOTAL and TASTE trials were done, trials of manual thrombectomy were powered for surrogate outcomes and were quite small.
Added value of this study
TOTAL is the largest randomised trial so far to compare routine manual thrombectomy to PCI alone during STEMI PCI.
Implications of all the available evidence
In an updated meta-analysis, manual thrombectomy did not reduce all-cause mortality or recurrent myocardial infarction but was associated with an increased risk of stroke. Consequently, manual thrombectomy can no longer be recommended as a routine strategy during PCI for STEMI.