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Published on: February 26, 2013
Outcomes 1 year after thrombus aspiration for myocardial infarction
Bo Lagerqvist1, Ole Fröbert, Göran K Olivecrona
1From the Department of Medical Sciences, Cardiology Section, and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L., O.O., S.K.J.), Department of Cardiology, Örebro University Hospital, Örebro (O.F., F.C.), Department of Coronary Heart Disease, Skane University Hospital, Clinical Sciences Section, Lund University, Lund (G.K.O., M.G., A.L.), Department of Cardiology, Karolinska Institutet, Södersjukhuset (P.A., O.C.), and Department of Cardiology, Karolinska Institutet, Danderyd (R.L.), Stockholm, Department of Cardiology, Umeå University Hospital, Umeå (J.A.), Section of Cardiology, Kalmar County Hospital and Linnaeus University, Kalmar (J.C.), Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., J.O., E.O.), Department of Cardiology, Skaraborgs Hospital, Skövde (A.K.), Department of Radiology, Ryhov Hospital, Jönköping (V.P.), Department of Cardiology, Linköping University Hospital, Linköping (T.T.), and Department of Radiology, Mälarsjukhuset, Eskilstuna (E.Z.) - all in Sweden; Department of Cardiology and Cardiovascular Research Center, Landspitali University Hospital, Reykjavik, Iceland (T.G.); and the Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (M.M.).
Insights
Routine thrombus aspiration in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) did not reduce 1-year mortality. This strategy did not significantly lower adverse cardiovascular events compared to PCI alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion therapy.
- Intracoronary thrombus aspiration is a procedure sometimes used before primary percutaneous coronary intervention (PCI).
- Previous studies have not definitively established the benefit of routine thrombus aspiration in reducing mortality for STEMI patients.
Purpose of the Study:
- To evaluate the clinical outcomes at 1 year following routine manual thrombus aspiration before primary PCI in patients with STEMI.
- To assess the impact of thrombus aspiration on all-cause mortality, rehospitalization for myocardial infarction, and stent thrombosis.
Main Methods:
- A registry-based randomized clinical trial involving 7244 STEMI patients.
- Patients were randomized to either manual thrombus aspiration followed by PCI or PCI alone.
- All-cause mortality at 1 year was a prespecified secondary endpoint.
Main Results:
- No significant difference in all-cause mortality at 1 year between the thrombus aspiration group (5.3%) and the PCI-only group (5.6%).
- Rates of rehospitalization for myocardial infarction (2.7% vs. 2.7%) and stent thrombosis (0.7% vs. 0.9%) were similar in both groups.
- The composite endpoint of death, myocardial infarction rehospitalization, or stent thrombosis showed no significant difference (8.0% vs. 8.5%).
Conclusions:
- Routine manual thrombus aspiration before primary PCI in STEMI patients does not improve 1-year clinical outcomes.
- The procedure did not reduce the rate of death, myocardial infarction, or stent thrombosis at the one-year follow-up.
- Findings suggest that routine thrombus aspiration is not beneficial for STEMI patients undergoing primary PCI.
Background:
Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration.
Methods:
We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial.
Results:
No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P=0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P=0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P=0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P=0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI.
Conclusions:
Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year. (Funded by the Swedish Research Council and others; TASTE ClinicalTrials.gov number, NCT01093404.).
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