Clinical outcomes associated with failed thrombus aspiration during primary percutaneous coronary intervention

Thrombus aspiration is performed during primary percutaneous coronary intervention (PCI) to improve outcomes in patients with ST-elevation myocardial infarction (STEMI). However, its success varies, and failed aspiration may impact prognosis. This study aimed to determine the predictors and clinical outcomes associated with failed thrombus aspiration. This retrospective study included 5323 patients who underwent primary PCI for STEMI. Patients were categorized into failed and successful thrombus aspiration groups. Baseline characteristics, angiographic findings, and procedural details were compared. Multivariate logistic regression identified independent predictors of aspiration failure, and clinical outcomes were analyzed over one-year. Failed thrombus aspiration occurred in 1176 patients (22.1%). Independent predictors included age ≥ 65 years, diabetes, hypertension, multi-vessel disease, high thrombus burden, and longer fluoroscopy time (all P < .001). Patients with failed aspiration had significantly higher in-hospital mortality (13.9% vs 5.6%), no-reflow (35.3% vs 6.5%), cardiogenic shock, and major adverse cardiovascular events (all P < .001). One-year mortality and heart failure hospitalizations were also increased. Failed thrombus aspiration is associated with worse short- and long-term outcomes in STEMI patients undergoing primary PCI. Identifying high-risk patients may help optimize procedural strategies and improve outcomes.