CLOT+

Restoration of epicardial patency with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) does not necessarily translate into adequate tissue-level reperfusion. Adjunctive intracoronary thrombolysis has been proposed to improve microvascular perfusion, but randomized data remain heterogeneous. This study sought to evaluate the efficacy and safety of adjunctive intracoronary thrombolysis during primary PCI for STEMI. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing adjunctive intracoronary thrombolysis plus primary PCI versus control in patients with STEMI. The primary endpoint was major adverse cardiovascular events (MACE). Secondary endpoints included major bleeding, post-procedural TIMI flow grade 2/3, TIMI myocardial perfusion grade, ST-segment resolution, and corrected TIMI frame count (CTFC). Random-effects models were used to estimate pooled treatment effects. Fifteen RCTs with 2,604 patients were included. Compared with control, adjunctive intracoronary thrombolysis was associated with a significantly lower risk of MACE (risk ratio [RR]: 0.66; 95% confidence interval [CI]: 0.52 to 0.84; p < 0.001). Intracoronary thrombolysis also improved postprocedural TIMI flow grade 2/3 (RR: 1.08; 95% CI: 1.02 to 1.13; p = 0.005), TIMI myocardial perfusion grade (RR: 1.25; 95% CI: 1.08 to 1.43; p = 0.002), and ST-segment resolution (RR: 1.17; 95% CI: 1.10 to 1.25; p < 0.001), and reduced CTFC (mean difference: -4.49 frames; 95% CI: -6.25 to -2.72; p < 0.001). Major bleeding was infrequent and did not differ significantly between groups (OR: 1.40; 95% CI: 0.63 to 3.11). In STEMI patients undergoing primary PCI, adjunctive intracoronary thrombolysis was associated with lower MACE and improved angiographic and electrocardiographic markers of myocardial reperfusion without a significant increase in major bleeding.

No subscriber has commented on this article yet.