BACKGROUND AND OBJECTIVES: Effective myocardial reperfusion following primary percutaneous coronary intervention for AMI, in lesions with a thrombus, is limited by distal embolization and slow/no reflow phenomenon. We evaluated the safety and efficacy of a thrombus reduction technique, using the export aspiration catheter for thrombosuction prior to primary PCI for AMI. SUBJECTS AND METHODS: We analyzed 61 AMI patients who had a thrombus burden on angiography, after having undergone primary PCI, either with or without EAC (EAC group; n=31, 24 males, mean ages 54.7+/-11.8 years)(control group; n=31, 20 males, mean ages 65.5+/-12.2 years). After the primary PCI, the angiographic findings and clinical outcomes at 1 and 6 months were recorded. RESULTS: The procedural and angiographic success rates were 100 (31/31) and 93.5 (29/31), and 100 (31/31) and 87.1% (27/31), respectively. After PCI, the recovery rate to TIMI 3 flow was higher in the EAC than the control group (26/31 vs. 20/31, p<0.05), and the corrected TIMI frame count was less in the EAC than the control group (23.9+/-15.1 vs. 34.8+/-22.5, p<0.05). However, there were no different in the TIMI perfusion grade between the two groups. Although there was no statistical significance, distal embolization was more commonly observed in control (16.1%, 5/31) than the EAC group (0/31)(p=0.056). There were no differences in the incidences of MACE at 1 (0 vs. 7.7%, p=0.237) and 6 months (6.9 vs. 0%, p=0.500) between two groups. In the 31 patients who underwent successful thrombosuction, gross thrombi were obtained from 25 (80.6%). CONCLUSION: In AMI, the use of thrombosuction, with EAC prior to PCI, provides a simple, rapid and potentially effective method for removal of the thrombus burden and restoration of coronary flow.