TACTIC Coronary Thrombus Aspiration With Cath Rx In Anterior Myocardial Infarction: A Randomized Control Trial.

Prior treatment

• Unwitnessed cardiac arrest OR ≥30 minutes of cardiopulmonary resuscitation (CPR) prior to enrolment OR any cardiac arrest with impairment in mental status, cognition or any global or focal neurological deficit
• New onset of stroke symptoms and NIHSS \>2, prior to index procedure
• Administration of fibrinolytic therapy within 24 hours prior to enrolment
• History or known hepatic insufficiency prior to catheterization
• Undergoing a renal replacement therapy
• Known or evidence of prior MI, including pathologic Q-waves in non-anterior leads
• Prior coronary artery bypass graft surgery (CABG) or LAD PCI
• History of heart failure (documented history of EF \<40% or documented hospitalization for HF within 1 year prior to screening
• Prior aortic valve surgery or TAVR
• History of stroke/TIA within 3 months prior to screening

Other illness

• STEMI due to stent thrombosis
• Active severe bleeding
• Severe hepatic/kidney impairment
• Inferior STEMI or suspected right ventricular failure
• Acute cardiac mechanical complication: LV-free wall rupture OR interventricular septum rupture OR acute mitral regurgitation
  • Medical Conditions \& History:
• Suspected systemic active infection
• Chronic obstructive pulmonary disease (COPD) with home oxygen therapy or on chronic steroid therapy

Lab values

• Cardiogenic shock defined as systemic hypotension (systolic BP \<90 mmHg or the need for inotropes/pressors to maintain a systolic BP \>90 mmHg), plus one (1) of the following: any requirement for pressors / inotropes prior to arrival at the catheterization laboratory, clinical evidence of end-organ hypoperfusion, or use of IABP or any other mechanical circulatory support device
• Contraindication to perform MRI or use gadolinium \[creatinine clearance (CrCl) \<30 mL/min, non-compatible implant, claustrophobia\]
  • Cardiovascular history

Other

• Unable to give Informed consent.
• Life expectancy \< 1 year.
• Contraindication to PCI
• Spontaneous coronary aretery dissection
• Patient undergone any kind of maneuvers to restore flow before randomization
• Known intolerance to aspirin, clopidogrel, ticagrelor, heparin, contrast media.
• Severe valvulopathy
• Suspected or known pregnancy
• Left bundle branch block (new or old)

• Age \>18 and \<75 years old
• Acute anterior STEMI with ≥2 mm in two (2) or more contiguous anterior leads or ≥4 mm total ST-segment deviation sum in the anterior leads V1-V4 AND anterior wall motion abnormality noted on a diagnostic quality left ventriculogram or echocardiogram
• Culprit lesion proximal or mid LAD at coronary angiography
• TIMI thrombus grading \> 3 or TIMI flow 0 after guidewire crossing the lesion.
• Patient presents to the hospital between 1 - 6 hours of ischemic pain onset
• Patient indicated for primary percutaneous coronary intervention (PPCI)