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Intracoronary antithrombotic therapy during primary percutaneous coronary intervention in patients with STEMI: A
Min Jung Geum1, Yun Mi Yu2, Jinyoung Jeon3
1Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Insights
Intracoronary non-recombinant tissue plasminogen activators (non-rtPAs) and small molecule glycoprotein IIb/IIIa inhibitors effectively prevent no-reflow during PCI, especially in prolonged ischemia. These therapies improve outcomes without increasing mortality or bleeding.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The no-reflow phenomenon complicates percutaneous coronary intervention (PCI), potentially impairing myocardial reperfusion.
- Intracoronary (IC) antithrombotic therapy is a potential strategy to mitigate no-reflow, but its comparative efficacy is not well-established.
Conclusions:
- Intracoronary non-rtPAs and small molecule glycoprotein IIb/IIIa inhibitors show promise as adjunctive therapies for PCI.
- These agents are particularly beneficial for patients experiencing longer periods of ischemia.
- Further research may refine the role of these antithrombotics in optimizing PCI outcomes.
Introduction:
The efficacy of intracoronary (IC) antithrombotic therapy, which may best prevent the no-reflow phenomenon during percutaneous coronary intervention (PCI), remains unclear. Therefore, we compared the efficacy and safety of different IC antithrombotic agents.
Materials And Methods:
This systematic review and network meta-analysis of randomized controlled trials (RCTs) compared IC fibrinolytic agents (recombinant tissue plasminogen activators [rtPAs] and non-rtPAs) or glycoprotein IIb/IIIa inhibitors (small molecules and monoclonal antibodies) with placebo by searching the relevant studies published before September 21, 2022. Bayesian network meta-analyses were performed using random-effects models.
Results:
Twenty-five RCTs with 4546 patients were included. Non-rtPAs and small molecules were significantly more effective in achieving thrombolysis in myocardial infarction (TIMI) grade 3 flow than placebo (odds ratio [OR] 2.28, 95 % credible intervals [CrI] 1.24-4.13; OR 2.06, 95 % CrI 1.17-3.46). Moreover, these agents' efficacy was observed in other microcirculation-related outcomes, including TIMI myocardial perfusion grade 3, complete ST-segment resolution, and corrected TIMI frame counts. Within 6 months, small molecules were associated with both an improved left ventricular ejection fraction (MD 3.90, 95 % CrI 0.48-7.46) and major adverse cardiac events (MACE) reduction (OR 0.36, 95 % CrI 0.20-0.61). Non-rtPAs demonstrated a reduced MACE incidence within 6 months (OR 0.51, 95 % CrI 0.31-0.81). The results were consistent in the subgroup with a total ischemic time > 6 h. No significant differences in mortality or bleeding events were observed.
Conclusions:
IC non-rtPAs and small molecules may be effective for adjunctive therapy to PCI, particularly in patients with longer ischemia periods.
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