Impact of aspiration catheter size on thrombus removal and slow-flow/no-reflow in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: Thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients with a high thrombus burden remains an important clinical consideration. This study aimed to evaluate the impact of aspiration catheter size on thrombus removal and the slow-flow/no-reflow phenomenon.

METHODS: This retrospective study included 208 STEMI patients presenting within 12 h of symptom onset with high thrombus burden. All underwent primary PCI with thrombus aspiration. Patients were divided based on catheter size: 7-French ( n = 85) and 6-French ( n = 123). Clinical characteristics, procedural outcomes, and angiographic results were compared. Multivariate logistic regression identified independent predictors of slow-flow/no-reflow.

RESULTS: Patients treated with a 7-French catheter had a lower incidence of slow-flow/no-reflow after stent deployment (14.0 vs. 36.6%; P < 0.001) and postdilatation (25.0 vs. 55.2%; P = 0.003). Final thrombolysis in myocardial infarction 3 flow was more frequently achieved in the 7-French group (100 vs. 90.2%; P = 0.032). History of stroke or transient ischemic attack [odds ratio (OR): 5.16; P = 0.021] and ischemic time greater than 330 min (OR: 2.13; P = 0.032) were predictors of no-reflow, while use of a 7-French catheter was protective (OR: 0.26; P < 0.001).

CONCLUSION: In STEMI patients with high thrombus burden, using a 7-French aspiration catheter was associated with higher procedural success and lower incidence of slow-flow/no-reflow. Larger-caliber catheters may offer a clinical advantage in selected patients undergoing primary PCI.