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Intracoronary Thrombolysis in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous
Sophia Alexiou1, Dimitrios Patoulias2, Konstantinos C Theodoropoulos3
12nd Cardiology Department, Medical School, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Road, 54642, Thessaloniki, Greece.
Insights
Intracoronary thrombolysis (ICT) as an add-on to primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) reduces major adverse cardiac events and improves microcirculation. This meta-analysis found no significant increase in major bleeding risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Primary percutaneous coronary intervention (PPCI) is the standard reperfusion therapy for ST-segment elevation myocardial infarction (STEMI).
- Intracoronary thrombolysis (ICT) is investigated as an adjuvant therapy to reduce thrombotic burden and microvascular obstruction.
- No-reflow phenomenon remains a challenge in STEMI treatment.
Approach:
- A comprehensive meta-analysis was conducted, adhering to the PRISMA statement.
- Searched major scientific databases including PubMed, Scopus, Cochrane Library, and Web of Science.
- Included 13 randomized controlled trials (RCTs) with 1876 patients comparing ICT + PPCI versus PPCI alone.
Key Points:
- ICT significantly reduced major adverse cardiac events (MACE) in STEMI patients (OR 0.65).
- Improved 6-month left ventricular ejection fraction (MD 3.78) and myocardial microcirculation indices (TIMI frame count, MBG, ST-resolution) were observed with ICT.
- No significant increase in major bleeding events was detected between groups (OR 1.27).
Conclusions:
- Adjuvant ICT in STEMI patients undergoing PPCI is associated with better clinical outcomes and improved myocardial reperfusion.
- The findings suggest a potential benefit of ICT in reducing MACE and enhancing microvascular function.
- Further validation in large, contemporary RCTs is recommended to confirm these benefits.
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 < 0.00001); myocardial blush grade (MBG) 2/3 (OR 1.76; 95% CI, 1.16-2.69, P = 0.008), and complete ST-segment resolution (OR 1.97; 95% CI, 1.33-2.91, P = 0.0007)). The odds for major bleeding were comparable between the 2 groups (OR 1.27; 95% CI, 0.61-2.63, P = 0.53).
Conclusions:
The present meta-analysis suggests that ICT was associated with improved MACE and myocardial microcirculation in STEMI patients undergoing PPCI, without significant increase in major bleeding. However, these findings necessitate confirmation in a contemporary large RCT.
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