A subanalysis of the special thrombectomy devices to avoid clinical heterogeneity as much as possible. Second, we included 6 additional studies and the results of the recent TASTE trial at the 1-year follow-up in this meta-analysis. Third, this meta-analysis presented fewer long-term clinical benefits of routine use of manual thrombus aspiration in patient with STEMI. Finally, we also assessed the level of evidence using the GRADE approach. The present meta-analysis showed that the composite MACE outcomes were significantly lower in the manual thrombus aspiration arm with long-term follow-up. However, the number of included patients for this clinical outcome was far less than for the others because the TASTE trail could not be included due to MACEs not being predefined in this trail. In the TASTE trial, the composite incidence of death, rehospitalization for myocardial infarction, or stent thrombosis was 8.0% in the thrombus-aspiration group and 8.5% in the PCI-only group. Nutlin-3 Adding these factors together, we could not conclude that the use of manual thrombus aspiration devices could reduce the composite MACE outcomes. In our meta-analysis, one trial warrants particular attention. The TASTE trial, a registry-based RCT, was a prospective, multicenter, controlled trial that randomly allocated 7,244 patients to undergo manual thrombus aspiration followed by PCI or PCI alone. The sample size was larger than those of all previous studies combined, and the power to detect differences at well-defined end points was much higher. The TASTE study did not show any significant differences in the primary outcome of all-cause mortality, and it showed non-significant trends toward less myocardial infarction and stent thrombosis at 30 days and 1 year of follow-up. Additionally, the outcome of thrombus aspiration in candidate subjects not enrolled in TASTE failed to show an advantage of this adjunct, although this meta-analysis found that adjunctive manual thrombosis aspiration significantly reduced the incidence of reinfarction at 30 days of follow-up. Based on the rate of reinfarction with short-term follow-up, 238 patients needed to be treated to prevent 1 reinfarction event. Given that the price of an average aspiration catheter is approximately J250,the potential clinicoeconomic effectiveness of the use of routine manual thrombosis aspiration is low. Different inclusion criteria and different manual aspiration thrombectomy devices were used in the various trials, and it is not surprising that there was significant statistical heterogeneity in the results of post-procedure myocardial reperfusion. For example, myocardial reperfusion was not improved and infarct size was not reduced by manual aspiration thrombectomy in the INFUSEAMI trial of patients with large anterior STEMI. Postprocedure myocardial reperfusion improvements were observed despite the inclusion of the recent INFUSE-AMI trial. A random effects model was employed in the meta-analysis, and there were still significant advantages of angiographic and electrocardiographic outcomes in the manual thrombus aspiration arm when individually excluding the included trials.