Thromboaspiration in Patients With High Thrombotic Burden Undergoing Primary Percutaneous Coronary Intervention (PCI)

Inclusion Criteria: 1. Prolonged, continuous signs and symptoms of ischemia lasting more than 20 min, starting within 12 hours prior to randomization, and ST elevation ≥ 2mm in ≥2 contiguous ECG leads, or new left bundle branch block (LBBB) 2. Presence of high thrombotic burden in the culprit lesion at diagnostic angiography (defined as the presence of a thrombus size ≥ 2 times the diameter of the vessel, according to a visual estimate, or abrupt cut-off occlusion of a coronary artery ≥3 mm in reference vessel diameter) 3. Written informed consent Exclusion Criteria: * Low-risk (ST elevation in ≤2 leads) inferior AMI * Previous infarction in the same area (assessed by ECG) * PCI in the 2 weeks prior to AMI * Active internal bleeding * History of cerebrovascular accident in the previous 2 years or cerebrovascular accident with a significant residual neurological deficit * Head or spine surgery or trauma in the previous 2 months * Recent (within six weeks) gastrointestinal (GI) or genitourinary (GU) bleeding of clinical significance * Administration of oral anticoagulants within seven days unless prothrombin time is \<1.2 times control * Bleeding diathesis or severe uncontrolled arterial hypertension * Thrombocytopenia (\<100 000 cells/mL) * Recent (within six weeks) major surgery or trauma * Intracranial neoplasm, arteriovenous malformation, or aneurysm * Severe renal or liver failure * Allergy to aspirin * Contraindication to MRI examination * Pregnancy and lactation