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Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and

Rasha Kaddoura1, Mohamed Izham Mohamed Ibrahim2, Daoud Al-Badriyeh2

  • 1Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.

Plos One
|May 5, 2022
PubMed

Insights

Intracoronary thrombolytics significantly improve myocardial perfusion and reduce major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients compared to aspiration thrombectomy. Glycoprotein IIb/IIIa inhibitors showed no significant benefit.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Management

Background:

  • High thrombus burden in STEMI patients complicates treatment and worsens outcomes.
  • Effective strategies are needed to reduce thrombus load and improve myocardial reperfusion.
  • Current approaches include aspiration thrombectomy and pharmacological interventions.

Purpose of the Study:

  • To compare the efficacy of intracoronary thrombolytics or glycoprotein IIb/IIIa inhibitors (GPI) versus aspiration thrombectomy (AT) as adjuncts to percutaneous coronary intervention (PCI) in STEMI patients.
  • To evaluate procedural and clinical outcomes associated with these interventions.
  • To determine the optimal strategy for managing thrombus burden in STEMI.

Main Methods:

  • A meta-analysis of randomized controlled trials comparing intracoronary thrombolytics/GPI with AT in STEMI patients undergoing PCI.
  • Literature search conducted across multiple databases (MEDLINE, EMBASE, CENTRAL).
  • Primary outcomes included procedural success measures like TIMI flow grade 3, TIMI myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3, and ST-segment resolution (STR).

Main Results:

  • Twelve trials with 1,466 patients were analyzed.
  • Intracoronary thrombolytics significantly improved TIMI flow grade 3, complete ST-segment resolution, and TMPG 3.
  • Thrombolytics also significantly reduced major adverse cardiovascular events (MACE) without increasing bleeding risk.
  • Intracoronary GPI did not improve procedural or clinical outcomes compared to AT.

Conclusions:

  • Intracoronary thrombolytics are superior to aspiration thrombectomy in improving myocardial perfusion and reducing MACE in STEMI patients.
  • Aspiration thrombectomy and glycoprotein IIb/IIIa inhibitors did not demonstrate significant benefits over thrombolytics.
  • Thrombolytics represent a valuable therapeutic option for managing thrombus burden in STEMI.
Abstract

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