Stent-Retriever Thrombectomy Reduced Infarct Size in STEMI

The NATURE trial, published in the Journal of the American College of Cardiology, found that adding stent-retriever thrombectomy to conventional percutaneous coronary intervention (PCI) reduced infarct size compared with conventional PCI alone in patients with ST-segment elevation myocardial infarction (STEMI) and large thrombus burden.

Patients with myocardial infarction and heavy thrombus burden face greater infarct size and higher mortality, and according to the study authors, no effective therapy previously existed for this high-risk subgroup. The trial tested whether stent-retriever thrombectomy followed by conventional PCI could limit myocardial damage beyond conventional PCI alone.

In this open-label, multicenter superiority trial, 160 patients with STEMI and large thrombus burden (TIMI thrombus grade ≥3 in the infarct-related artery) were consented, and 156 were randomly assigned to stent-retriever thrombectomy followed by conventional PCI or conventional PCI alone. The primary outcome was infarct size assessed by the area under the curve for creatine kinase-MB. It was lower in the stent-retriever group (n=78) than in the conventional PCI group (n=76): 3,965 IU/L·h (Q1-Q3: 2,480-5,092) versus 5,250 IU/L·h (Q1-Q3: 3,506-7,449); difference, −1,359 (95% CI, −2,231 to −522; P=0.001).

On exploratory cardiac magnetic resonance imaging, infarct size was also lower in the stent-retriever group (n=64; 17%; Q1-Q3: 11%-28%) than in the conventional PCI group (n=59; 28.0%; Q1-Q3: 18%-33%). Left ventricular volumes and ejection fraction did not differ between groups. Major adverse cardiovascular events—cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke—were numerically fewer in the stent-retriever group: none at 3 days and one at 30 days, versus two and three events, respectively, in the conventional PCI group.

The investigators concluded that stent-retriever thrombectomy followed by conventional PCI was associated with reduced infarct size in patients with large thrombus burden undergoing primary PCI within 8 hours of symptom onset. Although the trial reported major adverse cardiovascular event counts at 3 and 30 days, those limited event data do not establish a clinical outcome benefit. The trial is registered as NCT04969471.

Source: Valgimigli M, Frigoli E, Landi A, et al. Stent Retriever Thrombectomy in Patients With Myocardial Infarction: The Open-Label, Multicenter NATURE Superiority Trial. JACC. Published online September 22, 2026. doi:10.1016/j.jacc.2026.08.034