Key result
Intracoronary rhTNK-tPA linked to ~79% lower odds of regional wall motion abnormalities after primary PCI.
Why the study?
Acute STEMI with high thrombus burden often results in impaired myocardial perfusion despite epicardial recanalization, and evidence is limited on whether intracoronary rhTNK-tPA reduces microvascular obstruction and preserves ventricular function.
Does adjunctive intracoronary rhTNK-tPA during primary PCI improve early left ventricular regional wall motion in STEMI patients with high thrombus burden?
Cohort (n=136)
No
Does adjunctive intracoronary rhTNK-tPA during primary PCI improve early left ventricular regional wall motion in STEMI patients with high thrombus burden?
Adjunctive intracoronary rhTNK-tPA during primary PCI for high-thrombus STEMI is associated with improved early regional left ventricular wall motion and coronary reperfusion indices without increasing major bleeding.
May improve early LV wall motion in high-thrombus STEMI PCI; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Acute ST-segment elevation myocardial infarction (STEMI) with high thrombus burden often shows impaired myocardial perfusion despite successful epicardial recanalization. Intracoronary recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) may reduce microvascular obstruction and preserve ventricular function, but evidence is limited. METHODS: This single-center retrospective cohort study included 136 STEMI patients with high thrombus burden undergoing primary PCI between May 2022 and February 2025. Patients receiving intracoronary rhTNK-tPA (n=62) were compared with controls receiving standard PCI alone (n=74). The primary endpoint was left ventricular regional wall motion status within 7 days after PCI, assessed by WMSI and normal ventricular wall motion. Secondary endpoints included cTFC, ST-segment resolution, final TIMI flow grade, and clinical and safety outcomes. RESULTS: Baseline characteristics were generally comparable. The rhTNK-tPA group had lower WMSI values (P<0.001) and a higher incidence of normal ventricular wall motion (41.7% vs. 19.6%; P=0.014). rhTNK-tPA was also associated with lower post-PCI cTFC (18.18 ± 6.91 vs. 21.24 ± 9.20; P=0.033) and higher ST-segment resolution (83.9% vs. 68.9%; P=0.043), while final TIMI grade 3 flow was similar. In multivariable analysis, rhTNK-tPA was independently associated with lower odds of ventricular wall motion abnormalities (OR=0.214; 95% CI, 0.106-0.433; P<0.001). MACE were infrequent, and no intracranial hemorrhage occurred. CONCLUSION: Adjunctive intracoronary rhTNK-tPA during primary PCI was associated with better early preservation of regional wall motion and improved reperfusion indices without an observed increase in major bleeding.
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Lai et al. (2026) conducted a cohort in Acute ST-segment elevation myocardial infarction (STEMI) with high thrombus burden (n=136). Adjunctive intracoronary recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) during primary PCI vs. Standard primary PCI alone was evaluated on Left ventricular regional wall motion status within 7 days after PCI, assessed by WMSI and normal ventricular wall motion (OR 0.214, 95% CI 0.106-0.433, p=<0.001). Adjunctive intracoronary rhTNK-tPA lowered the odds of wall motion abnormalities (OR 0.214; 95% CI 0.106-0.433; P<0.001) and increased normal wall motion (41.7% vs 19.6%; P=0.014).
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