Intracoronary thrombolysis facilitated primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients: an updated meta-analysis of randomized controlled trials

Abstract

Abstract Background Primary percutaneous coronary intervention (PPCI) is the standard reperfusion treatment in ST-segment elevation myocardial infarction (STEMI). However, PPCI is often complicated by microvascular obstruction. Intracoronary thrombolysis (ICT) may mitigate thrombotic burden. Methods We conducted, according to the PRISMA statement, the largest meta-analysis of ICT as adjuvant therapy to PPCI. All relevant studies were identified by searching the PubMed, Scopus, Cochrane Library, and Web of Science, with no time or language restriction. The odds ratio (OR) and mean difference (MD) with a 95% confidence interval (CI) were calculated. Studies included STEMI patients undergoing PPCI receiving ICT. Both safety and efficacy outcomes were analyzed. Data were combined using a random-effects model. Results Thirteen randomized controlled trials (RCTs) involving a total of 1876 (1014 ICT) patients were included. Compared with the control group, ICT in STEMI patients could reduce the incidence of major adverse cardiac events (MACE) (OR 0.65, 95% CI, 0.48–0.86, P=0.003) and improve 6 months left ventricular ejection fraction (MD 3.78, 95% CI, 1.53–6.02, P=0.0010). Indices of enhanced myocardial microcirculation were more common with ICT [Post PCI corrected thrombolysis in myocardial infarction (TIMI) frame count (MD −3.57; 95% CI, −5.00 to −2.14, P<0.00001); myocardial blush grade (MBG) 2/3 (OR 1.76; 95% CI, 1.16–2.69, P=0.008), and complete ST-segment resolution (OR 1.97; 95% CI, 1.33–2.91, P=0.0007). The incidence rate of major bleeding was comparable between the 2 groups (OR 1.27; 95% CI, 0.61–2.63, P=0.53). Conclusions Intracoronary thrombolysis was associated with improved MACE and myocardial microcirculation in patients with STEMI undergoing PPCI, without any significant increase in major bleeding. Our meta-analysis suggests that a targeted ICT is safe and potentially effective to improve PPCI. Nonetheless, the above results necessitate verification in a contemporary large RCT. Funding Acknowledgement Type of funding sources: None.