Key result
Thrombus aspiration during STEMI PCI is linked to greater 12-month myocardial scar reduction vs PCI alone.
Why the study?
While thrombus aspiration during primary PCI aims to reduce distal embolization and microvascular obstruction in STEMI, its impact on long-term myocardial scar and remodeling remains debated.
Does thrombus aspiration during primary PCI improve myocardial scar reduction at 12 months in STEMI patients?
Observational (n=130)
No
Does thrombus aspiration during primary PCI improve myocardial scar reduction at 12 months in STEMI patients?
Thrombus aspiration during primary PCI in STEMI patients with high thrombus burden may optimize conditions for myocardial scar reduction at 12 months despite worse baseline characteristics.
Answers are grounded in this paper and cite their sources.
Supports selective thrombus aspiration during primary PCI in STEMI; extends randomized surrogate evidence for myocardial recovery.
BACKGROUND: Microvascular obstruction (MVO) is a major prognostic determinant in STEMI. While thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) aims to reduce distal embolization and MVO, its impact on long-term myocardial scar and remodeling remains debated. The present study aimed to evaluate the impact of clinically indicated TA on myocardial scar and MVO using cardiac magnetic resonance (CMR) at baseline and 12-month follow-up in STEMI patients treated with PCI. METHODS: In this single-center observational cohort study, consecutive STEMI patients treated with primary PCI ± TA who underwent CMR at baseline and at 12 months were enrolled. CMR parameters included left ventricular volumes, ejection fraction, global longitudinal strain, infarct size (late gadolinium enhancement) and MVO. RESULTS: Among 130 STEMI patients (84 PCI + TA, 46 PCI-alone) enrolled, the TA group had higher baseline thrombus burden (TIMI Thrombus Grade 5 [5;5] vs. 3 (Henriques et al., 2002; Byrne et al., 2023 [2, 5]), p < 0.001), higher MVO prevalence (44.6% vs. 25%, p = 0.03) and larger infarct size [late gadolinium enhancement LGE: 24.2% vs 17.5% of left ventricle (LV) myocardial mass, p = 0.001]. At follow-up CMR, PCI + TA group experienced a greater reduction in myocardial scar (-5.0% [-21.8; 1.4] vs. -3.28% [-17.9; 4.6], p < 0.05), particularly in patients with a high thrombus burden (Thrombus Grade > 3) and baseline MVO (-10.3% [-19.8; -2.5] vs. -3.7% [-9.5; 1.2], p < 0.05). CONCLUSIONS: Despite worse baseline clinical and imaging characteristics, STEMI patients treated with TA showed more favorable myocardial tissue recovery at 12 months. These findings suggest that TA may optimize conditions for scar consolidation, particularly in high-risk patients with heavy thrombus burden.
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Torto et al. (2026) conducted an observational in STEMI (n=130). Thrombus aspiration (TA) + PCI vs. PCI-alone was evaluated on Reduction in myocardial scar at 12 months (p=<0.05). Thrombus aspiration during primary PCI for STEMI was associated with a greater reduction in myocardial scar at 12 months compared to PCI alone (-5.0% vs. -3.28%, p < 0.05).
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