Patients with ST elevation myocardial infarction (STEMI) <6 hours from pain onset and occluded infarct-related artery in baseline angiography were randomized into aspiration thrombectomy followed by direct stenting (TS, n = 100) or standard balloon predilatation followed by stent implantation (n = 96). The primary end point of the study was the electrocardiographic ST-segment elevation resolution >70 % (STR > 70 % ) 60 minutes after primary angioplasty (percutaneous coronary intervention [PCI]). Secondary end points included angiographic myocardial blush grade (MBG) after PCI, combination of STR > 70 % immediately after PCI and MBG grade 3 (optimal myocardial reperfusion), Thrombolysis In Myocardial Infarction flow after PCI, angiographic complications, and in-hospital major adverse cardiac events.
Aspiration thrombectomy success rate was 91 % (crossing of the lesion with thrombus reduction and flow restoration). There was no significant difference in STR ≥ 70 % after 60 minutes (53.7 % vs 35.1 % , P = .29). STR > 70 % immediately after PCI (41 % vs 26 % , P < .05), MBG grade 3 (76 % vs 58 % , P < .03), and optimal myocardial reperfusion (35.1 % vs 11.8 % , P < .001) were more frequent in TS. There was no difference in between the groups in 6-month mortality (4 % vs 3.1 % , P = .74) and reinfarction rate (1 % vs 3.1 % , P = .29).
Aspiration thrombectomy and direct stenting is safe and effective in STEMI patients with early presentation (<6 hours). The angiographic parameters of microcirculation reperfusion and ECG ST-segment resolution directly after PCI were significantly better in thrombectomy group despite the lack of the difference in ST-segment resolution 60 minutes after PCI.