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Updated: Jun 11, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Intracoronary Thrombolysis During Primary PCI for STEMI: An Updated Meta-Analysis of Randomized-Controlled Trials
Song Peng Ang1, Dwani Patel1, Jia Ee Chia2
1Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona.
The American Journal of Cardiology
|June 9, 2026
Summary
Adjunctive intracoronary thrombolysis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) significantly lowers major adverse cardiovascular events (MACE). This approach improves myocardial reperfusion markers without increasing major bleeding risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Primary percutaneous coronary intervention (PCI) restores epicardial patency in ST-segment elevation myocardial infarction (STEMI) but may not ensure adequate tissue reperfusion.
- Adjunctive intracoronary thrombolysis is explored to enhance microvascular perfusion, yet existing randomized data are inconsistent.
Purpose of the Study:
- To assess the efficacy and safety of adding intracoronary thrombolysis to primary PCI in STEMI patients.
- To provide a comprehensive meta-analysis of randomized controlled trials (RCTs) on this intervention.
Main Methods:
- Systematic review and meta-analysis of 15 RCTs involving 2,604 STEMI patients.
- Comparison of adjunctive intracoronary thrombolysis plus primary PCI versus primary PCI alone.
- Primary endpoint: Major adverse cardiovascular events (MACE). Secondary endpoints: bleeding, TIMI flow, myocardial perfusion, ST resolution, and corrected TIMI frame count (CTFC).
Main Results:
- Adjunctive thrombolysis significantly reduced MACE (RR: 0.66; 95% CI: 0.52-0.84).
- Improved post-procedural TIMI flow grade 2/3, TIMI myocardial perfusion grade, and ST-segment resolution were observed.
- Reduced CTFC indicated better microvascular reperfusion (mean difference: -4.49 frames).
- Major bleeding rates were similar between groups.
Conclusions:
- Adjunctive intracoronary thrombolysis in STEMI patients undergoing primary PCI is linked to reduced MACE.
- The intervention enhances angiographic and electrocardiographic markers of myocardial reperfusion.
- No significant increase in major bleeding complications was detected.
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