Compared with conventional PCI alone, stent-retriever thrombectomy followed by PCI was associated with reduced infarct size in patients with large thrombus burden undergoing primary PCI less than eight hours from symptom onset, based on findings from the NATURE Superiority study presented at ESC Congress 2026 and simultaneously published in JACC.

The trial involved 160 patients with STEMI and large thrombus burden who were randomized to stent retriever thrombectomy followed by conventional PCI or conventional PCI alone. The primary outcome was infarct size extension, while the safety outcome was major adverse cardiovascular events at three and 30 days.

Overall results showed infarct size was lower in the stent retriever group (n=78) compared with the conventional group (n=76). Additionally, exploratory cardiac magnetic resonance findings found infarct size was lower in the stent-retriever group (n=64; left ventricle, 17%; IQR 11–28) vs. the conventional PCI group (n=59; 28.0%; IQR 18–33), but no significant differences were observed in left ventricular volumes and ejection fraction. In terms of major adverse events, there were two incidents at three days and three incidents at 30 days in the conventional PCI group compared with no adverse events in the stent retriever group.

“The use of a stent retriever should be investigated in future trials to assess whether thrombus burden mitigation before conventional PCI reduces morbidity and mortality in patients with STEMI and a large thrombus burden,” said Marco Valgimigli, MD, PhD, et al.

In a related editorial comment, Ziad A. Ali, MD, DPhil, noted that STEMI trials have repeatedly asked for decades about whether adding another treatment improves primary PCI. “NATURE asks a more useful question,” he said. “Can we improve the order in which PCI is performed? The answer is not yet definitive, but the signal is provocative. Sometimes progress does not require a new finality; it requires a new first move.”

Visit the JACC Journals at ESC Congress 2026 page to see the full list of simultaneous publications, information about editor-in-chief meet and greets, and more!

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: ESC Congress, ESC26, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction