Primary PCI has become synonymous with STEMI in these days. But limitation of primary PCI is time and resources, only few centers are capable of performing this procedure. Recently published trial in JACC and also reported by LearnOnly Heart where thrombectomy was done in patients with plaque erosion and balloon dilation or stent deployment was not done, and it showed beneficial results. In this trial plaque erosion was present in 40% of patients, plaque erosion was detected by OCT. Another article published in Euro intervention also states advantages of just thrombectomy in STEMI patients
With advent of newer thrombolytic agents i.e. aggregate of biodegradable nanoparticles that have been coated with tissue plasminogen activator (tPA) these particle get activated much like platelets, in area of increased shear stress i.e. obstructed vessels thus they release drug locally. This reduces dose of thrombolytic by 100 fold, reduce chances of bleeding.
This reduced chance of bleeding with improved efficacy of drug and no need of many resources to administer these nanoparticles and also just thrombectomy without balloon angioplasty or stent is showing benefit; probably in future these newer thrombolytics may over take primary PCI in STEMI patients