Thrombus aspiration during ST-segment elevation myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• The benefit of routine intracoronary thrombus aspiration prior to primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) remains unclear.
• Evaluating the impact of thrombus aspiration on mortality in STEMI patients is crucial for clinical practice guidelines.

Purpose of the Study:

• To determine if routine manual thrombus aspiration, preceding primary PCI, reduces all-cause mortality in patients with STEMI.
• To assess the efficacy of thrombus aspiration in improving outcomes beyond PCI alone.

Main Methods:

• A multicenter, prospective, randomized, controlled, open-label trial involving 7244 STEMI patients undergoing PCI.
• Patients were randomized to either manual thrombus aspiration followed by PCI or PCI alone.
• Outcomes were evaluated through national registries, with the primary endpoint being 30-day all-cause mortality.

Main Results:

• No significant difference in 30-day all-cause mortality between the thrombus aspiration group (2.8%) and the PCI-only group (3.0%) (HR 0.94; 95% CI 0.72-1.22; P=0.63).
• Rates of recurrent myocardial infarction, stent thrombosis, stroke, and neurological complications were not significantly different between the groups.
• Results were consistent across prespecified subgroups, including those based on thrombus burden and initial coronary flow.

Conclusions:

• Routine thrombus aspiration before primary PCI in STEMI patients does not decrease 30-day mortality compared to PCI alone.
• The findings suggest that routine thrombus aspiration is not beneficial for reducing mortality in this patient population.