1. Thrombus aspiration versus conventional primary PCI in STEMI patients V. Mironov Russian Cardiology Research Center 2014

2. Do we need thrombus aspiration?

3. Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009 No-reflow mechanism

4. Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009 Reperfusion

5. Primary endpoint: Myocardial blush grade P < 0.001 Thrombus aspirationConventional PCI TAPAS %

6. ST-segment elevation resolution P < 0.001 Thrombus aspirationConventional PCI TAPAS

7. Myocardial blush grade and death or death/reinfarction at 30-days Myocardial blush grade P = 0.001 TAPAS %

8. TAPAS one year outcome: Myocardial blush grade and death or death/reinfarction at 1 year P = 0.001 Myocardial blush grade TAPAS %

9. Mortality at 1 year Log-Rank p = 0.040 TAPAS

10. Log-Rank p = 0.016 Mortality or non-fatal ReMI at 1 year TAPAS

11. 472 STEMI pts Conventional pPCI N=232 PCI+TA n=240 Success of TA N=228 Impossible of TA N=12 Stenting Primary EP: “optimal” reperfusion: TIMI III, MBG 3, ST resolution Secondary EP: MACE No-reflow in STEMI Russian Cardiology Research Center

12. Russian Cardiology Research Center Primary end point pPCIThrombus aspirationp TIMI 0-117 (7.3%)2 (0,9%)0,002 TIMI 242 (18,1%)18 (7,9%) TIMI 3173 (74,6%)94 (91,2%) MBG 0-136 (15,5%)21 (9,2%)0,003 MBG 2118 (50,8%)32 (14%) MBG 378 (33,7%)175 (76,8%) Resolution of ST > 70%80 (34,5%)138 (60,5%)0,02 Balloon dilatation206 (88,8%)33 (14,5%)0,001

13. P = 0.001 Optimal reperfusion (TIMI III, MBG 3, ST resolution>70%) %

14. P = 0.001 In-hospital mortality %

15. Russian Cardiology Research Center MACE 2y FU 11,5% Months % P=0,002

16. 65 yo male patient with STEMI Диссекция среднего отдела ствола ЛКА Пациент с многососудистым поражением коронарного русла с вовлечением ствола ЛКА

17. Result and 1 year follow up

19. Kaplan–Meier Curves for Death from Any Cause and Hospitalization Due to Reinfarction. Kaplan–Meier curves are shown for the cumulative probability of death from any cause (Panel A) and of hospitalization due to reinfarction (Panel B) up to 30 days after PCI only (PCI) or after PCI with thrombus aspiration (PCI+TA). The insets show the same data on an enlarged y axis.

20. 51 years old male patient Infero-lateral STEMI. Paroxysmal AF.