Outcomes of Manual Thrombus Aspiration in Patients with Acute Myocardial Infarction and High Thrombus Burden Treated by Primary Angioplasty.

Background: Despite improving myocardial reperfusion, there are still controversies regarding the impact of thrombus aspiration (TA) in patients with ST elevation myocardial infarction treated (STEMI) treated with primary percutaeous coronary intervention (PCI). Our aim was to assess efficacy and long-term outcomes of TA in STEMI patients with a high thrombus burden. Methods: Out of 174 STEMI patients, 104 patients treated with conventional primary PCI and 70 patients did adjunctive manual TA. Baseline demographic, angiographic, and procedural characteristics were reported in all patients. Clinical outcomes including all cause mortality, cardiac death, reinfarction, stent thrombosis, target lesion revascularization (TLR), and stroke were reported in patients with manual TA during one year follow up, and compared to patients with standard PCI alone. Results: Post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 and ST resolution > 70% were significantly observed in 91.4% and 90.0% of patients with manual TA compared to 72.1% and 74.0% of patients without manual TA (P=0.005 and 0.009, respectively). During one year follow-up, there were no significant differences between both groups regarding the incidence of cardiac death (P=0.79), all cause mortality (P=0.89), reinfarction (P=0.82), stent thrombosis (P=0.32) and TLR (P=0.75). Interestingly, stroke was reported in 1.7% of patients with no significant difference (P=0.81) regarding its incidence between no TA group (1.9%) and TA group (1.4%). Conclusions: Compared to conventional PCI alone, adjunctive manual TA in STEMI patients with a high thrombus burden significantly enhances myocardial reperfusion, without significant benefits regarding mortality or clinical outcomes during one year follow up.