Quality scores ranged from 2 to 9 points.
Nine RCTs (2,417 participants) were included. Most studies were small; one larger trial contributed 1,071 participants.
Adjunctive manual thrombectomy reduced the risk of death at 30 days compared to percutaneous coronary intervention alone (1.7% versus 3.1%, OR 0.58, 95% CI 0.34 to 0.98, p=0.04, heterogeneity p=0.97; 2,401 participants). Tests showed no evidence of publication bias. Sensitivity analyses showed no differences between groupings (see paper for details).
Adjunctive manual thrombectomy also resulted in increased benefits for procedural TIMI 3 flow (OR 1.59, 95% CI 1.26 to 2.0; 2,235 participants), myocardial blush grade 3 perfusion (OR 2.44, 95% CI 2.04 to 2.92; 2,172 participants) and distal embolisation (OR 0.30, 95% CI 0.20 to 0.44; 1,207 participants).