Related Experiment Video

Updated: Jun 11, 2026

Prehospital Thrombolysis: A Manual from Berlin
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
PubMed

Insights

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.

Keywords:
ST-segment elevation myocardial infarctionintracoronarymortalitymyocardial reperfusionoutcome researchpercutaneous coronary interventionthrombolysis

More Related Videos

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Related Concept Videos

Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...