Aspiration Thrombectomy (See Section 5.5.2 of the 2011 PCI guideline and Section 4.2 of the 2013 STEMI guideline for additional recommendations.) Class IIa recommendation for aspiration thrombectomy before primary PCI was based on the results of 2 RCTs29,31,32 and 1 meta-anal- and was driven in large measure by the results of TAPAS (Thrombus Aspiration During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Study), a single- center study that randomized 1071 patients with STEMI to aspiration thrombectomy before primary PCI or primary PCI Three multicenter trials, 2 of which enrolled signifi- cantly more patients than prior aspiration thrombectomy tri- als, have prompted reevaluation of this recommendation. In the INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial of 452 patients with anterior STEMI due to proximal or mid-left anterior descending occlusion, infarct size was not reduced by aspiration thrombectomy before primary PCI. The TASTE (Thrombus Aspiration During ST-Segment Elevation Myocardial Infarction) trial (n=7244) incorporated a unique design that allowed randomization within an exist- ing national registry, resulting in enrollment of a remarkably high proportion of eligible patients.34,36 No significant 30-day or 1-year differences were found between the group that received aspiration thrombectomy before primary PCI and the group that received primary PCI only with regard to death, reinfarc- tion, stent thrombosis, target lesion revascularization, or a com- posite of major adverse cardiac events. The TOTAL (Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI) trial randomized 10,732 patients with STEMI to aspiration thrombectomy before primary PCI or pri- mary PCI only.35 Bailout thrombectomy was performed in 7.1% of the primary PCI only group, whereas the rate of crossover from aspiration thrombectomy before primary PCI to primary PCI only was 4.6%. 