Intracoronary Thrombolysis in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: an Updated Meta-analysis of Randomized Controlled Trials

Background Primary percutaneous coronary intervention (PPCI) is the standard reperfusion treatment in ST-segment elevation myocardial infarction (STEMI). Intracoronary thrombolysis (ICT) may reduce thrombotic burden in the infarct-related artery, which is often responsible for microvascular obstruct...

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Published in:Cardiovascular drugs and therapy 2024-04, Vol.38 (2), p.335-346
Main Authors: Alexiou, Sophia, Patoulias, Dimitrios, Theodoropoulos, Konstantinos C., Didagelos, Matthaios, Nasoufidou, Athina, Samaras, Athanasios, Ziakas, Antonios, Fragakis, Nikolaos, Dardiotis, Efthimios, Kassimis, George
Format: Article
Language:English
Subjects:
Angioplasty
Bleeding
Cardiology
Clinical trials
Heart
Heart attacks
Hemorrhage
Humans
Medicine
Medicine & Public Health
Meta-analysis
Microvasculature
Myocardial infarction
Myocardial Infarction - therapy
Percutaneous Coronary Intervention - adverse effects
Randomized Controlled Trials as Topic
Reperfusion
Review Article
Segments
ST Elevation Myocardial Infarction - diagnostic imaging
ST Elevation Myocardial Infarction - therapy
Thrombolysis
Thrombolytic Therapy - adverse effects
Treatment Outcome
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Summary:Background Primary percutaneous coronary intervention (PPCI) is the standard reperfusion treatment in ST-segment elevation myocardial infarction (STEMI). Intracoronary thrombolysis (ICT) may reduce thrombotic burden in the infarct-related artery, which is often responsible for microvascular obstruction and no-reflow. Methods We conducted, according to the PRISMA statement, the largest meta-analysis to date of ICT as adjuvant therapy to PPCI. All relevant studies were identified by searching the PubMed, Scopus, Cochrane Library, and Web of Science. Results Thirteen randomized controlled trials (RCTs) involving a total of 1876 patients were included. Compared to the control group, STEMI ICT-treated patients had fewer major adverse cardiac events (MACE) (OR 0.65, 95% CI, 0.48–0.86, P  = 0.003) and an improved 6-month left ventricular ejection fraction (MD 3.78, 95% CI, 1.53–6.02, P  = 0.0010). Indices of enhanced myocardial microcirculation were better with ICT (Post-PCI corrected thrombolysis in myocardial infarction (TIMI) frame count (MD − 3.57; 95% CI, − 5.00 to − 2.14, P  
ISSN:0920-3206
1573-7241
1573-7241
DOI:10.1007/s10557-022-07402-3