OBJECTIVES: To conduct an updated meta-analysis on clinical outcomes with thrombectomy prior to primary percutaneous coronary intervention (PPCI) compared with conventional PPCI alone. BACKGROUND: The clinical efficacy of thrombectomy in acute myocardial infarction (AMI) remains uncertain. METHODS: Clinical trials that randomized AMI patients to aspiration or mechanical thrombectomy prior to PPCI compared with conventional PPCI alone were included. RESULTS: The weighted mean duration of clinical follow-up was 6 months. Aspiration thrombectomy vs. conventional PPCI (18 trials, n=3,936): Major adverse cardiac events (MACE) (Risk ratio [RR]=0.76; 95% CI 0.63-0.92; p=0.006) and all-cause mortality (RR=0.71, 95% CI 0.51-0.99; p=0.049) were significantly reduced with aspiration thrombectomy. Beneficial trends were noted for MI (p=0.11) and target vessel revascularization (p=0.06). Final infarct size (p=0.64) and ejection fraction (p=0.32) at 1 month were similar. ST-segment resolution (STR) at 60 minutes (RR=1.31; 95% CI 1.16-1.48; p<0.0001) and TIMI blush grade (TBG) 3 post-procedure (RR=1.37; 95% CI 1.19-1.59; p<0.0001) were both improved with aspiration thrombectomy. Mechanical thrombectomy vs. conventional PPCI (7 trials, n=1,598): There was no difference between the thrombectomy and conventional PPCI arms in the incidence of MACE (RR=1.10; 95% CI 0.59-2.05; p=0.77), mortality (p=0.57), MI (p=0.32), target vessel revascularization (p=0.19), or final infarct size (p=0.47). A benefit in STR at 60 minutes (RR=1.25; 95% CI 1.06-1.47; p=0.007), but not TBG 3 (RR=1.09; 95% CI 0.86-1.38; p=0.48) was noted. CONCLUSIONS: Thrombectomy during AMI by manual catheter aspiration, but not mechanically, is beneficial in reducing MACE, including mortality, at 6 to 12 months compared with conventional PCI alone.