Safety and Efficacy of Intracoronary Thrombolysis as Adjunctive Therapy to Primary PCI in STEMI: A Systematic Review and Meta-analysis |
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| Authors: | Motasem Alyamani Sandra Campbell Eliano Navarese Robert C. Welsh Kevin R. Bainey |
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| Affiliation: | 1. Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada;2. Faculty of Pharmacy, Laval University, Québec, Québec, Canada;3. Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada;4. Faculty of Medicine, Laval University, Québec, Québec, Canada;5. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada;1. Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada;2. Division of Cardiology, University of Toronto, Toronto Congenital Cardiac Centre for Adults, Toronto General and Mount Sinai Hospitals, Toronto, Ontario, Canada;3. Division of Cardiothoracic Surgery, Toronto General Hospital and Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada;4. Canada Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada;1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;2. Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China;3. Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China;4. Beijing Anzhen Hospital, Capital Medical University, Beijing, China;5. The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Capital Medical University, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China;6. Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou;1. London Health Sciences Centre, London, Ontario, Canada;2. Department of Medicine, Western University, London, Ontario, Canada;3. Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Ontario, Canada;4. Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada;1. Québec Heart-Lung Institute, Laval University, Québec, Québec, Canada;2. Cardiology Department, European Hospital Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France |
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| Abstract: | BackgroundPrimary percutaneous coronary intervention (PPCI) is the preferred method of reperfusion in ST-elevation myocardial infarction. However, microvascular perfusion is often impaired due to distal embolization of thrombus. Intracoronary (IC) thrombolysis may attenuate thrombotic burden. We conducted a meta-analysis comparing the benefits and risks of IC thrombolytic therapy as an adjunct to PPCI.MethodsRandomized controlled trials (RCTs) were identified through search of Medline, EMBASE, Scopus, Web of Science, Cochrane Library (Cochrane Reviews and Cochrane Protocols), PROSPERO, and clinicaltrials.gov from 1946 to January 2019. Studies included patients with ST-elevation myocardial infarction undergoing primary PCI receiving IC thrombolytic agents. Both safety and efficacy outcomes were explored. Data were combined using a fixed-effects model.ResultsOf 1278 citations identified, 6 RCTs (890 patients; 519 IC thrombolytic and 371 IC placebo) were included. Post-PCI thrombolysis in myocardial infarction (TIMI) flow grade 2/3 occurred in 97.1% of the IC thrombolytic group vs 95.1% of the IC placebo group (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.28-1.17; P = 0.13). Complete ST-segment resolution was more common with IC thrombolysis (OR, 0.29; 95% CI, 0.15-0.57; P = 0.0003). There was a strong trend favouring fewer in-hospital major adverse cardiac events with IC thrombolysis when compared with IC placebo (OR, 0.64; 95% CI, 0.41-1.01; P = 0.05). There was no difference in bleeding (TIMI major, TIMI minor, and Bleeding Academic Research Consortium [BARC] 3-5 bleeds) between the 2 groups (OR, 1.36; 95% CI, 0.38-3.54; P = 4.84).ConclusionsGiven the limited studies to date, our meta-analysis suggests that a targeted IC thrombolytic approach is safe and potentially effective to augment PPCI. However, these findings deserve confirmation in a larger RCT. |
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