Rajan Rehan, Sohaib Virk, Christopher C Y Wong, Freda Passam, Jamie Layland, Anthony Keech, Andy Yong, Harvey D White, William Fearon, Martin Ng
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The primary outcome was major adverse cardiac events (MACE). The pooled risk ratio (RR) and weighted mean difference (WMD) with a 95% CI were calculated.</p><p><strong>Results: </strong>12 studies with 1915 patients were included. IC thrombolysis was associated with a significantly lower incidence of MACE (RR=0.65, 95% CI 0.51 to 0.82, I<sup>2</sup>=0%, p<0.0004) and improved left ventricular ejection fraction (WMD=1.87; 95% CI 1.07 to 2.67; I<sup>2</sup>=25%; p<0.0001). Subgroup analysis demonstrated a significant reduction in MACE for trials using non-fibrin (RR=0.39, 95% CI 0.20 to 0.78, I<sup>2</sup>=0%, p=0.007) and moderately fibrin-specific thrombolytic agents (RR=0.62, 95% CI 0.47 to 0.83, I<sup>2</sup>=0%, p=0.001). No significant reduction was observed in studies using highly fibrin-specific thrombolytic agents (RR=1.10, 95% CI 0.62 to 1.96, I<sup>2</sup>=0%, p=0.75). Furthermore, there were no significant differences in mortality (RR=0.91; 95% CI 0.48 to 1.71; I<sup>2</sup>=0%; p=0.77) or bleeding events (major bleeding, RR=1.24; 95% CI 0.47 to 3.28; I<sup>2</sup>=0%; p=0.67; minor bleeding, RR=1.47; 95% CI 0.90 to 2.40; I<sup>2</sup>=0%; p=0.12).</p><p><strong>Conclusion: </strong>Adjunctive IC thrombolysis at the time of primary PCI in patients with STEMI improves clinical and myocardial perfusion parameters without an increased rate of bleeding. 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引用次数: 0
摘要
背景：尽管急性ST段抬高型心肌梗死（STEMI）的心外膜血流得到恢复，但微循环灌注不足的情况仍很常见，预示着不良的预后。冠状动脉内（IC）溶栓疗法可减轻微血管血栓形成的负担；然而，当代的研究结果却相互矛盾：本荟萃分析旨在评估 STEMI 患者在接受初次经皮冠状动脉介入治疗（PCI）时辅助 IC 溶栓治疗的有效性和安全性：对六个电子数据库进行全面文献检索，确定了相关的随机对照试验。主要结果为主要心脏不良事件（MACE）。结果：共纳入 12 项研究，1915 名患者：结果：共纳入 12 项研究，1915 名患者。IC溶栓与MACE发生率显著降低相关（RR=0.65，95% CI 0.51至0.82，I2=0%，p2=25%；p2=0%，p=0.007），与中度纤维蛋白特异性溶栓剂相关（RR=0.62，95% CI 0.47至0.83，I2=0%，p=0.001）。在使用高度纤维蛋白特异性溶栓药物的研究中未观察到明显降低（RR=1.10，95% CI 0.62至1.96，I2=0%，P=0.75）。此外，死亡率（RR=0.91；95% CI 0.48至1.71；I2=0%；P=0.77）或出血事件（大出血，RR=1.24；95% CI 0.47至3.28；I2=0%；P=0.67；小出血，RR=1.47；95% CI 0.90至2.40；I2=0%；P=0.12）无明显差异：结论：对 STEMI 患者进行初级 PCI 时辅助 IC 溶栓可改善临床和心肌灌注参数，但不会增加出血率。需要进一步开展研究，以优化溶栓药物的选择和治疗方案。
Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis.
Background: Despite restoration of epicardial blood flow in acute ST-elevation myocardial infarction (STEMI), inadequate microcirculatory perfusion is common and portends a poor prognosis. Intracoronary (IC) thrombolytic therapy can reduce microvascular thrombotic burden; however, contemporary studies have produced conflicting outcomes.
Objectives: This meta-analysis aims to evaluate the efficacy and safety of adjunctive IC thrombolytic therapy at the time of primary percutaneous coronary intervention (PCI) among patients with STEMI.
Methods: Comprehensive literature search of six electronic databases identified relevant randomised controlled trials. The primary outcome was major adverse cardiac events (MACE). The pooled risk ratio (RR) and weighted mean difference (WMD) with a 95% CI were calculated.
Results: 12 studies with 1915 patients were included. IC thrombolysis was associated with a significantly lower incidence of MACE (RR=0.65, 95% CI 0.51 to 0.82, I2=0%, p<0.0004) and improved left ventricular ejection fraction (WMD=1.87; 95% CI 1.07 to 2.67; I2=25%; p<0.0001). Subgroup analysis demonstrated a significant reduction in MACE for trials using non-fibrin (RR=0.39, 95% CI 0.20 to 0.78, I2=0%, p=0.007) and moderately fibrin-specific thrombolytic agents (RR=0.62, 95% CI 0.47 to 0.83, I2=0%, p=0.001). No significant reduction was observed in studies using highly fibrin-specific thrombolytic agents (RR=1.10, 95% CI 0.62 to 1.96, I2=0%, p=0.75). Furthermore, there were no significant differences in mortality (RR=0.91; 95% CI 0.48 to 1.71; I2=0%; p=0.77) or bleeding events (major bleeding, RR=1.24; 95% CI 0.47 to 3.28; I2=0%; p=0.67; minor bleeding, RR=1.47; 95% CI 0.90 to 2.40; I2=0%; p=0.12).
Conclusion: Adjunctive IC thrombolysis at the time of primary PCI in patients with STEMI improves clinical and myocardial perfusion parameters without an increased rate of bleeding. Further research is needed to optimise the selection of thrombolytic agents and treatment protocols.
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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