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Intracoronary Thrombolysis in Patients With ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized

Ling Chen1, Liye Shi1, Wen Tian1

  • 1Department of Geriatric Cardiology, 159407The First Affiliated Hospital, China Medical University, Shenyang, China.

Angiology
|February 12, 2021
PubMed

Insights

Intracoronary thrombolysis in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) reduces major adverse cardiac events and improves heart function. However, it does not impact mortality rates.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • The role of intracoronary thrombolysis in ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI) is not well-defined.
  • Uncertainty exists regarding the net clinical benefit of adjunctive intracoronary thrombolysis in this high-risk population.

Purpose of the Study:

  • To evaluate the efficacy and safety of intracoronary thrombolysis when added to primary percutaneous coronary intervention in STEMI patients.
  • To determine the impact on major adverse cardiac events, cardiac function, and mortality.

Main Methods:

  • A systematic meta-analysis of randomized controlled trials was performed, adhering to PRISMA guidelines.
  • Literature searches were conducted across major databases (PubMed, EMBASE, Cochrane Library, Web of Science) without time or language restrictions.
  • Pooled risk ratios and weighted mean differences were calculated to synthesize outcomes.

Main Results:

  • Nine randomized controlled trials with 1341 patients were analyzed.
  • Intracoronary thrombolysis significantly reduced major adverse cardiac events (MACE) (RR 0.632) and improved left ventricular ejection fraction (RR 0.343).
  • No significant difference was observed in mortality (RR 0.759), and bleeding rates were comparable between groups.

Conclusions:

  • Intracoronary thrombolysis, when used with PPCI in STEMI patients, is associated with improved MACE and myocardial microcirculation.
  • The adjunctive therapy did not demonstrate a significant benefit in reducing mortality.
  • The safety profile regarding bleeding complications was similar to standard PPCI.
Abstract

Keywords:
ST-segment elevation myocardial infarctionintracoronarymajor adverse cardiac eventsmicrocirculationthrombolysis

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