Published on behalf of The Society for governed by the applicable Creative Commons License primary PCI only. [35] Bailout thrombectomy was per- formed in 7.1% of the primary PCI only group, whereas the rate of crossover from aspiration throm- bectomy before primary PCI to primary PCI only was 4.6%. There were no differences between the 2 treat- ment groups, either in the primary composite endpoint of cardiovascular death, recurrent MI, cardiogenic shock, or New York Heart Association class IV heart failure at 180 days, or in the individual components of the primary endpoint, stent thrombosis, or target-vessel revascularization. There was a small but statistically significant increase in the rate of stroke in the aspira- tion thrombectomy group. An updated meta-analysis that included these 3 trials among a total of 17 trials (n 20 960) found no significant reduction in death, reinfarction, or stent thrombosis with routine aspiration thrombectomy. Aspiration thrombectomy was associ- ated with a small but nonsignificant increase in the risk of stroke. [33] Several previous studies have found that higher thrombus burden in patients with STEMI is independ- ently associated with higher risks of distal emboliza- tion, no-reflow phenomenon, transmural myocardial necrosis, major adverse cardiac events, stent thrombo- sis, and death. [38 42] However, subgroup analyses from the TASTE and TOTAL trials did not suggest rel- ative benefit from aspiration thrombectomy before pri- mary PCI in patients with higher thrombus burden or in patients with initial Thrombolysis in Myocardial In- farction (TIMI) flow grade 0 1 or left anterior de- scending artery/anterior infarction. [34,35] On the basis of the results of these studies, the prior Class IIa recommendation for aspiration thrombectomy has been changed. Routine aspiration thrombectomy before primary PCI is now not recommended (Class III: No Benefit, LOE A). 