Thrombectomy during Percutaneous Coronary Intervention in Patients With St Elevation Myocardial Infarction

Adjunctive thrombectomy during percutaneous coronary intervention (PCI) involves the mechanical removal of thrombus prior to balloon inflation and stent deployment .This has been a topic of ongoing debate in the management of ST-elevation myocardial infarction (STEMI), with prior studies yielding mixed outcomes. In this retrospective cohort study utilizing the TriNetX network, we analyzed data from hospitalized STEMI patients who underwent PCI between January 1, 2016, and December 31, 2023, stratifying them based on the use of adjunctive thrombectomy. Out of 50,104 patients, 1,967 (3.9%) underwent thrombectomy. After 1:1 propensity score matching to adjust for baseline differences, we found no significant differences in 30-day or 1-year all-cause mortality (HR: 1.212; 95% CI: 1.044 to 1.406) or stroke risk (HR: 0.865; 95% CI: 0.400 to 1.870) between the thrombectomy and nonthrombectomy groups. However, patients in the thrombectomy group experienced higher rates of heart failure (HF) readmissions and blood transfusion requirements at 1 year. These findings suggest that while adjunctive thrombectomy does not appear to increase the risk of mortality or stroke, its association with adverse clinical outcomes such as HF and transfusion needs indicates that its use should be reserved for carefully selected patients, particularly those with a high thrombus burden. Further prospective studies are necessary to clarify its role and determine the patient populations most likely to benefit.