Level 1: Likely reliable evidence

Thrombus aspiration during percutaneous coronary intervention (PCI) reduced mortality and re-infarction rate at one year in a randomized trial of 1,071 patients (mean age 63 years) with ST-segment elevation MI (Lancet. 2008;371:1915-1920). Patients were randomized to thrombus aspiration during PCI vs. conventional PCI; the intervention group had treatment with a 6-Fr-compatible manual aspiration catheter after a guidewire was passed through the target lesion. A bare-metal stent was placed if a stent was indicated. Of the patients who began the study, 99% (1,060) underwent follow-up.

At one-year follow-up, thrombus aspiration was associated with a reduction in all-cause mortality (4.7% vs. 7.6%, P =.042, NNT 35), cardiac death (3.6% vs. 6.7%, P =.02, NNT 33), re-infarction (2.2% vs. 4.3%, P =.05, NNT 48), and combination of cardiac death or non-fatal re-infarction (5.6% vs. 9.9%, P =.009, NNT 24). There were no significant differences in rates of target-vessel revascularization.