Thrombus aspiration in primary percutaneous coronary intervention in high-risk patients with ST-elevation myocardial

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Published on: August 8, 2025

Fabio Mangiacapra1, William Wijns, Giuseppe De Luca

  • 1Cardiovascular Center, OLV Hospital, Moorselbaan 164, Aalst, Belgium. emanuele.barbato@olvz-aalst.be

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 26, 2010
PubMed

Insights

Thrombus aspiration before primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients improves coronary blood flow and myocardial perfusion. This approach also leads to better long-term survival and reduced major adverse cardiovascular events compared to conventional PCI.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Randomized clinical trials have demonstrated the benefits of catheter thrombus aspiration in primary PCI.
  • Real-world data is crucial to confirm these findings in a broader patient population.
  • ST-elevation myocardial infarction (STEMI) management aims to restore coronary blood flow rapidly.

Purpose of the Study:

  • To evaluate the effectiveness of thrombus aspiration in an unselected group of STEMI patients undergoing primary PCI.
  • To compare procedural and long-term clinical outcomes between patients treated with and without thrombus aspiration.
  • To assess the impact of thrombus aspiration on coronary flow and myocardial perfusion.

Main Methods:

  • A cohort of 313 STEMI patients with initial TIMI Flow Grade 0 or 1 in the infarct-related artery were included.
  • Patients were assigned to thrombus aspiration or conventional primary PCI based on operator discretion.
  • Procedural success, coronary flow (TIMI Frame Count, TIMI Flow Grade), myocardial perfusion (Myocardial Blush Grade), and clinical outcomes at 30 days and one year were compared.

Main Results:

  • Thrombus aspiration (n=194) was associated with significantly improved post-PCI coronary flow (lower TIMI Frame Count, higher TIMI Flow Grade 3) and myocardial perfusion (higher Myocardial Blush Grade 3) compared to conventional PCI (n=119).
  • No significant difference in clinical outcomes was observed at 30 days.
  • At one year, thrombus aspiration significantly reduced the risk of overall mortality (HR 0.41) and major adverse cardiovascular events (MACE) (HR 0.49).

Conclusions:

  • In real-world STEMI patients with occluded infarct-related arteries, thrombus aspiration prior to primary PCI enhances coronary flow and myocardial perfusion.
  • Thrombus aspiration is associated with improved long-term clinical outcomes, including increased overall survival and reduced MACE.
  • These findings support the use of thrombus aspiration as an adjunct to primary PCI in selected STEMI patients.
Abstract

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