Adjunctive Intracoronary Fibrinolytic Therapy During Primary Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Microvascular obstruction (MVO) occurs in ~50% of patients post-primary percutaneous coronary intervention (PCI), worsening prognosis.
• No current evidence-based treatments exist for MVO.
• Distal embolization of atherothrombotic debris and microvascular thrombi are key contributors to MVO.

Purpose of the Study:

• To critically appraise evidence on adjunctive intracoronary fibrinolytic therapy during primary PCI.
• To describe ongoing randomized trials in this field.
• To highlight clinical uncertainties for future research.

Main Methods:

• Systematic review and appraisal of published randomized trials.
• Description of ongoing randomized trials investigating intracoronary fibrinolytic therapy.
• Synthesis of available evidence to draw conclusions.

Main Results:

• Primary PCI restores epicardial patency but MVO remains a significant issue.
• Intracoronary fibrinolysis may reduce thrombotic burden and subsequent distal embolization.
• Evidence from existing trials on the efficacy of this adjunctive therapy is appraised.

Conclusions:

• Adjunctive intracoronary fibrinolytic therapy is a potential strategy to mitigate MVO after primary PCI.
• Further research is needed to address clinical uncertainties and establish evidence-based treatments.
• Ongoing trials will provide crucial data on the role of intracoronary fibrinolysis in improving outcomes.