Thrombus aspiration during primary percutaneous coronary intervention: Where are we now?

Thrombus aspiration during primary percutaneous coronary intervention (pPCI) has been used to improve myocardial perfusion through a re du ction of the thrombotic burden eventually resul ting with better clinical outcomes.1,2 After the initial enthusiasm derived from the mortality reduction shown in early randomized and observational studies,3-7 disa ppointing results have been yielded in more recent larger scale trials testing the routine use of thrombus aspiration in pPCI.8-12 As a consequence, this technique has lost its initial appeal and currently is often neglected or even considered as a useless by the interventional cardiologists. The recent meta-analysis by Jolly et al.13 conducted in more than 18,000 patients once again re in forces the evidence that overall there is no benefit in the routine use of thrombus aspiration during pPCI. However, it has the merit to shed light on the residual potential of this technique, which has pro bably been dismissed too quickly. First, there were no significant differences in the occurrence of cardio va scular events up to 1-year post-pPCI between patients treated conventio nally versus those treated with routine adjunctive thrombus aspiration. Of interest, in the sub group of patients with large angiographic thrombus burden (i.e., TIMI thrombus grade ≥3), thrombus aspira tion was associated with a significant reduction in cardiovascular death [2.5 % vs. 3.1 %; hazard ratio 0.80, 95 % confidence interval (CI), 0.65–0.98, P=0.03]. This meta-analysis in fact assessed data from the three lar gest randomized trials on this topic, namely Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS),4,5 Throm bus Aspiration in ST elevation Myocardial Infarction in Scandinavia (TASTE)8,9 and