I read the report by Boghdady and Elbadry, recently published online in the American Journal of Cardiology . In their study, the authors reported that rescue percutaneous coronary intervention (PCI) with manual thrombus aspiration leads to better myocardial reperfusion and significant reduction of major adverse cardiac events (MACE) than PCI with no thrombus aspiration. Because of some major flaws in design of the study, I have some reservations about the findings of this report.

Thrombus aspiration may have beneficial effect on angiographic parameters. However, its prognostic value is not clear. Optimal medical therapy (OMT) is the key point to reduce MACE after myocardial infarction. In the study of Boghdady and Elbadry, there are no data about patients’ medications except antiplatelets. In our previous knowledge and according to current guidelines, it is recommended to use oral β blockers, long-term treatment with acetylsalicylic acid, dual-antiplatelet therapy for at least 12 months, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and aldosterone receptor antogonists (if left ventricle ejection fraction <40%) to reduce MACE in patients with ST-elevation myocardial infarction. Less treatment with OMT may be an important reason for greater MACE in patients with no thrombus aspiration. Hence, authors should state the incidence of patients treated with β blockers, statins, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and aldosterone antagonists for each group respectively and compare the groups regarding their medications.

Thrombus aspiration may have beneficial effect in rescue PCI. However, its relation with MACE is not clear. To define thrombus aspiration as a predictor of reduction in MACE, it should be proven that all patients were treated similarly with OMT.