Outcomes of Primary PCI With Thrombus Aspiration Versus No Aspiration in Patients Presenting With ST-Elevation Myocardial Infarction (STEMI): A Comparative Study

Background: Thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) has been proposed to enhance reperfusion by reducing thrombus burden. However, its clinical benefit remains uncertain. Aim: To compare angiographic, electrocardiographic, and early in-hospital outcomes between STEMI patients undergoing primary PCI with thrombus aspiration versus no aspiration. Materials and Methods: A prospective comparative study was conducted on 100 STEMI patients undergoing primary PCI. Patients were assigned to Group A (n = 50; PCI with thrombus aspiration) or Group B (n = 50; PCI without aspiration). Primary endpoints included TIMI 3 flow, myocardial blush grade (MBG), and ST-segment resolution. Secondary endpoints included no-reflow, distal embolization, and in-hospital major adverse cardiac events (MACE). Results: TIMI 3 flow was achieved more frequently in Group A (88%) than Group B (72%) (p = 0.04). MBG 3 occurred in 56% versus 34% (p = 0.02). Complete ST-segment resolution was higher with aspiration (68% vs 42%, p = 0.01). No-reflow and distal embolization were lower in the aspiration group, though not statistically significant (8% vs 20%, p = 0.08). In-hospital MACE and mortality showed nonsignificant trends favoring aspiration. Conclusion: Thrombus aspiration during primary PCI improves angiographic and electrocardiographic reperfusion in STEMI patients. Although early clinical outcomes were comparable, the overall reperfusion benefits support selective use of thrombus aspiration in patients with high thrombus burden