ASPIRATION THROMBECTOMY (See Section 5.5.2 of the 2011 PCI guideline and Section 4.2 of the 2013 STEMI guideline for additional recommendations.) The 2011 PCI and 2013 STEMI guidelines [9,10] Class IIa recommendation for aspiration thrombectomy before primary PCI was based on the results of 2 RCTs [29,31,32] and 1 meta-analysis [30] 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 only. [29,32] Three multicenter trials, 2 of which enrolled significantly more patients than prior aspiration thrombectomy trials, have prompted reevaluation of this recommendation. In the INFUSE-AMI (Intracoronary Abciximab and Aspi- ration Thrombectomy in Patients With Large Anterior Myocardial Infarction) trial [37] 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) incor- porated a unique design that allowed randomization within an existing national registry, resulting in enroll- ment of a remarkably high proportion of eligible patients. [34,36] No significant 30-day or 1-year differ- ences were found between the group that received aspi- ration thrombectomy before primary PCI and the group that received primary PCI only with regard to death, reinfarction, stent thrombosis, target lesion revasculari- zation, or a composite of major adverse cardiac events. The TOTAL (Trial of Routine Aspiration Thrombec- tomy With PCI Versus PCI Alone in Patients With STEMI) trial randomized 10,732 patients with STEMI to aspiration thrombectomy before primary PCI or 1006 Levine et al. Catheterization and Cardiovascular Interventions DOI 10.1002/ccd. Published on behalf of The Society for governed by the applicable Creative Commons License primary PCI only. 