Sonothrombolysis as an adjunct to primary PCI in STEMI: a systematic review and meta-analysis of randomized trials

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Ultrasound

Background:

• ST-elevated myocardial infarction (STEMI) is a critical condition requiring rapid reperfusion.
• Percutaneous coronary intervention (PCI) is a standard treatment, but optimizing outcomes remains crucial.
• Ultrasound-mediated thrombolysis (sonothrombolysis) is an emerging technique to enhance clot lysis.

Purpose of the Study:

• To evaluate the efficacy of sonothrombolysis as an adjunct to PCI in STEMI patients.
• To assess the impact of sonothrombolysis on cardiac function and infarct size.
• To synthesize evidence from randomized controlled trials (RCTs) on this combined therapy.

Main Methods:

• A systematic literature search was performed across five databases for relevant RCTs.
• Data from six RCTs involving 241 patients (sonothrombolysis + PCI) and 232 patients (PCI alone) were analyzed.
• A random effects model was used to assess outcomes including LVEF, LV volumes, LV-GLS, and infarct size.

Main Results:

• Sonothrombolysis significantly increased left ventricular ejection fraction (LVEF) immediately post-PCI and at follow-up.
• The combined therapy led to significantly lower left ventricular end-diastolic volume (LVEDV) and end-systolic volume (LVESV).
• Reduced infarct size and improved left ventricular global longitudinal strain (LV-GLS) were observed in the sonothrombolysis group.

Conclusions:

• Sonothrombolysis as an adjunct to PCI significantly improves cardiac function and reduces infarct size in STEMI patients.
• The therapy demonstrates enhanced LVEF, reduced ventricular volumes, and smaller infarcts.
• Further research into the standalone and adjunctive roles of sonothrombolysis with PCI is warranted.