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

Abstract

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.

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

“…The randomized clinical trial (RCT) TAPAS, in particular, showed that manual thrombus aspiration (TA) improved myocardial reperfusion and reduced mortality in STEMI patients at 1-year follow-up [5,6] . These results, confirmed by other studies [7][8][9][10] , including a meta-analysis [11] of 11321 patients from 20 RCT showing lower rates of late mortality, reinfarction and stent thrombosis in patients underwent manual TA compared with conventional primary PCI, led to a recommendation class Ⅱa for manual TA in patients undergoing primary PCI for STEMI [12] . Nevertheless, the use of the thrombectomy devices is still controversial and not routine in STEMI patients, especially because some studies have shown no impact on clinical outcome [13][14][15][16][17][18][19][20] , such as the TASTE trial [21] .…”

“…Unlike other studies with strict inclusion criteria [6,10] , this registry demonstrated no impact of TA on both short and long-term outcomes. In the TAPAS trial [5,6] , only patients with primary PCI were included; in another real-world registry [10] , only patients with primary PCI indication and TIMI flow 0-1 were included.…”

“…No-reflow was defined as a TIMI flow grade < 2 in absence of coronary dissection, coronary hematoma, occlusive coronary thrombosis or epicardial spasm [10] . Thrombus embolization was defined as circumscribed filling defects and/or abrupt cut off of a vessel distal to the target lesion or in other coronary vessel on the angiogram after PCI [23] .…”

“…tween patients treated with or without TA [6,7,10,20,28] except for one brief work [29] that demonstrated a higher stent diameter after manual TA, in STEMI patients treated with bare metal stents. Recently, the TASTE trial [21] also showed the need for fewer stents per procedure in manual TA group in comparison with conventional PCI.…”

“…In the TAPAS trial [5,6] , only patients with primary PCI were included; in another real-world registry [10] , only patients with primary PCI indication and TIMI flow 0-1 were included. Conversely, our clinical results are consistent with studies with broad inclusion criteria, such as the TASTE trial [21] , that evaluated the primary end-point at short-term and with the largest published real-world registry in manual TA [20] that had a very extended follow-up.…”