Should Thrombus Aspiration be routinely used in STEMI with TIMI 0 Flow

Patients with pre-procedural TIMI flow grade 0 had a higher incidence of myocardial blush grade ≤ 1 and no reflow and had greater myocardial damage as assessed by peak creatine kinase-MB fraction value compared with those with pre-procedural TIMI flow grade 2 to 3 [1]. Several explanations may account for the potential significance of pre-procedural TIMI flow grade on clinical outcomes in patients with STEMI undergoing primary PCI. Prolonged ischemia and late reperfusion can impair endothelial function and cause myocardial tissue edema and hemorrhage. It might explain why optimal epicardial recanalization, primary angioplasty for STEMI is still associated with suboptimal reperfusion in a relatively large proportion of patients, especially with late onset [2]. Therefore, rapid restoration of the infarct-related coronary artery has become a main goal in patients with ST-segment–elevation myocardial infarction (STEMI) [3,4]. Distal embolization of atherothrombotic material during primary percutaneous coronary intervention for ST-elevation myocardial infarction is an important cause of (partly) unsuccessful reperfusion [5]. Reducing the thrombus burden by using thrombus aspiration catheter is rational concept in primary PCI. A study showed that distal embolization was associated with a 5-fold increase in 5-year mortality [6]. However, the use of routine thrombus aspiration called into a question by data indicating not only a lack of efficacy but a risk of potentially deleterious complications [7].