The Role of Thrombectomy in Percutaneous Coronary Intervention for STEMI Patients

Background: Primary percutaneous coronary intervention (PCI) is the gold standard of ST-segment elevation myocardial infarction (STEMI). However, the presence of a heavy burden of thrombus can complicate the outcomes by inducing the possibility of distal embolization and no-reflow. Thrombectomy has been reinstated as a strategy of reperfusion enhancement, which is a controversial procedure. Objective: To identify the effectiveness of thrombectomy in primary PCI in STEMI patients at Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan. Methods: The prospective observational study was conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi in the duration from 15th December, 2024 to 15th June, 2025. Two hundred patients with STEMI who underwent PCI were recruited. Patients who had angiographically confirmed high thrombus load were subjected to selective thrombectomy, and the outcomes were compared across the cohort. Measured outcomes included clinical and angiographic outcomes (TIMI 3 flow, no-reflow, recurrent ischemia, heart failure, and in-hospital mortality). Results: The mean age of the patients was 58.4 years, with 76% of them being male. The burden of thrombus was great (64% of patients), and 22% of patients required bailout thrombectomy. TIMI 3 flow was achieved in 89 percent of the patients. No-reflow was noted in 8, in-hospital mortality was seen in 5, recurrent ischemia and heart failure in 6 and 10 cases, respectively. The selective use of thrombectomy was linked with better reperfusion and positive in-hospital outcomes. Conclusion: Selective thrombectomy is a helpful complement to PCI in high-thrombus-burden patients with STEMI. It enhances the performance of angiography and reduces complications, which justifies the importance of patient selection in a personal approach in the modern practice of interventional cardiology.