Thrombus aspiration in primary percutaneous coronary intervention in high-risk patients with ST-elevation myocardial infarction: A real-world registry

Objectives: To evaluate the effect of thrombus aspiration in a real-world all-comer patient population with STEMI undergoing primary PCI. Background: Catheter thrombus aspiration in primary PCI was beneficial in randomized clinical trials. Methods: We enrolled 313 STEMI patients presenting with TIMI Flow Grade 0 or 1 in the infarct related artery at baseline angiogram undergoing primary PCI. Patients were divided in two groups based on whether thrombus aspiration was attempted. This decision was left at operator's discretion. Procedural and long-term clinical outcomes were compared between the two groups. Results: Baseline characteristics were similar between groups: 194 (62%) received thrombus aspiration and 119 underwent conventional PCI. Thrombus aspiration was associated with significantly lower post-PCI TIMI Frame Count values (19 ± 15 vs. 25 ± 17; P = 0.002) and higher TIMI Flow Grade 3 (92% vs. 73%; P < 0.001). Postprocedural myocardial perfusion assessed by myocardial blush grade (MBG) was significantly increased in the thrombus aspiration group (MBG 3: 44% vs. 21%; P < 0.001). No significant difference was found between the two groups in clinical outcome at 30 days. At one year, patients treated with thrombus aspiration showed significantly higher overall survival (HR 0.41, 95% CI 0.20-0.81; log-rank P = 0.010) and MACE-free survival (HR 0.49, 95% CI 0.28-0.85; log-rank P = 0.011). Conclusions: In real-world all-comer STEMI patients with occluded infarct-related artery, thrombus aspiration prior to PCI improves coronary flow, myocardial perfusion, and long-term clinical outcome as compared with PCI in the absence of thrombus aspiration.