The CAPTURE AMI trial is an investigator-initiated, single-centre, two-arm, randomised controlled trial. Patients aged ≥ 18 years who present with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) will be enrolled after angiographic evidence of a high thrombus burden (TIMI thrombus grade ≥ 4) and meeting the inclusion criteria laid out in section 9.2 will be 1:1 randomised to receive either standalone PCI (Arm 1) or adjunct sustained mechanical thrombectomy + PCI (Arm 2).

The CAPTURE AMI study will enrol specifically patients with:

A. Evidence of high thrombus burden on coronary angiography (TIMI thrombus grade ≥ 4) B. Culprit in an artery with a diameter of 3.0 mm or more. The trial is designed to evaluate the efficacy of sustained mechanical thrombectomy versus standalone PCI in patients with a large thrombus burden assessed angiographically, with a pre-stent thrombus burden (%) as the primary imaging endpoint.

Inclusion Criteria:

• Primary PCI patient with ST elevation myocardial infarction

• Angiographic criteria:

  • TIMI 0/1 flow at presentation
  • Angiographic thrombus score ≥ 4
  • Vessel diameter at site of occlusion ≥ 3.0mm (determined by coronary angiography)

Exclusion Criteria:

• Female participant who is pregnant or lactating
• Unconscious at presentation
• Late STEMI presentation (symptoms onset to wire time > 12 h)
• Clinically/haemodynamically unstable patients
• Known diagnosis of severe renal disease (CKD stage 4-5)
• Suspected spontaneous coronary artery dissection
• Previous CABG
• Previous history on STEMI in the same culprit territory
• Known moderate-severe anaemia (Hb < 9)