Key result
Intracoronary thrombolysis during primary PCI for STEMI cuts MACE by ~37% versus control.
Why the study?
The effects of intracoronary thrombolysis therapy in patients with STEMI receiving PPCI remained unclear.
Does intracoronary thrombolysis reduce major adverse cardiac events in patients with STEMI receiving primary percutaneous coronary intervention?
Meta-Analysis (n=1,341)
Does intracoronary thrombolysis reduce major adverse cardiac events in patients with STEMI receiving primary percutaneous coronary intervention?
Effect estimate: RR 0.632 (95% CI 0.474-0.843)
p-value: p=.002
Intracoronary thrombolysis during primary PCI for STEMI significantly reduces major adverse cardiac events and improves left ventricular ejection fraction without increasing bleeding risk, though it does not improve mortality.
Supports adjunctive intracoronary thrombolysis in STEMI primary PCI; confirms MACE reduction across Level 1 evidence.
Background: The effects of intracoronary (IC) thrombolysis therapy in patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) remain unclear. Methods: The meta-analysis was conducted according to the PRISMA statement. All relevant studies were identified by searching the PubMed, EMBASE, Cochrane Library, and Web of Science, with no time or language limitation. The pooled risk ratio (RR) and weighted mean difference (WMD) with a 95% CI were calculated. Results: Nine randomized controlled trials involving a total of 1341 patients were included. Compared with the control group, IC thrombolysis in patients with STEMI could reduce the incidence of major adverse cardiac events (MACE; RR 0.632, 95% CI, 0.474-0.843, P = .002) and improve left ventricular ejection fraction (RR 0.343, 95% CI, 0.178-0.509, P < .001) and myocardial microcirculation. However, there was no difference noted in the mortality (RR 0.759, 95% CI, 0.347-1.661, P = .490). The incidence rate of major bleeding and minor bleeding was comparable between the 2 groups. Conclusions: Intracoronary thrombolysis was associated with improved MACE and myocardial microcirculation in patients with STEMI having PPCI, though it failed to improve mortality.
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Chen et al. (2021) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=1,341). Intracoronary thrombolysis vs. Control was evaluated on Major adverse cardiac events (MACE) (RR 0.632, 95% CI 0.474-0.843, p=.002). Intracoronary thrombolysis in patients with STEMI undergoing primary PCI significantly reduced major adverse cardiac events compared with control (RR 0.632; 95% CI 0.474-0.843; P=0.002).
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