Does Thrombus Aspiration Improve Outcomes of Primary Percutaneous Coronary Intervention?

Microvascular obstruction due to distal thrombus embolization during primary percutaneous coronary intervention impairs myocardial perfusion and is associated with adverse outcomes. In this randomized trial, partially funded by the manufacturer of the study device, 1071 patients with ST-segment-elevation MI were assigned to either manual thrombus aspiration or a conventional procedure (generally, balloon dilation) before stent delivery as appropriate during PCI. All patients received a loading dose of clopidogrel, and abciximab was administered to more than 90%.

Atherothrombotic material was aspirated in 72.9% of patients and mostly consisted of platelet thrombi. The primary study endpoint, myocardial blush grade of 0 or 1, occurred in 17.1% of patients in the thrombus-aspiration group versus 26.3% in the conventional-PCI group (P<0.001). The rate of complete ST-segment resolution postprocedure was higher in the thrombus-aspiration group than in the conventional-PCI group (56.6% vs. 44.2%, P<0.001). Clinical outcomes at 30 days favored the aspiration group, with lower rates of death (2.1% vs. 4.0%), reinfarction (0.8% vs. 1.9%), and overall major adverse events (6.8% vs. 9.4%), but the differences were not statistically significant. However, the rates of death and other adverse events did significantly correlate with blush grade of 0 or 1 and resolution of ST-segment elevation.