PDF(Pubmed)
Abstract：
Thrombus load in STEMI patients remains a challenge in practice. It aggravates coronary obstruction leading to impaired myocardial perfusion, worsened cardiac function, and adverse clinical outcomes. Various strategies have been advocated to reduce thrombus burden.
This meta-analysis aimed to evaluate the effectiveness of intracoronary-administered thrombolytics or glycoprotein IIb/IIIa inhibitors (GPI) in comparison with aspiration thrombectomy (AT) as an adjunct to percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction (STEMI).
A comprehensive literature search for randomized trials that compared intracoronary-administered thrombolytics or GPI with AT in STEMI patients who underwent PCI, was conducted using various databases (e.g., MEDLINE, EMBASE, CENTRALE). Primary outcome was procedural measures (e.g., TIMI flow grade 3, TIMI myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3, ST-segment resolution (STR)).
Twelve randomized trials enrolled 1,466 patients: 696 were randomized to intracoronary-administered pharmacological interventions and 553 to AT. Patients randomized to PCI alone were excluded. Thrombolytics significantly improved TIMI flow grade 3 (odds ratio = 3.71, 95% CI: 1.85-7.45), complete STR (odds ratio = 3.64, 95% CI: 1.60-8.26), and TMPG 3 (odds ratio = 5.31, 95% CI: 2.48-11.36). Thrombolytics significantly reduced major adverse cardiovascular events (MACE) (odds ratio = 0.29, 95% CI: 0.13-0.65) without increasing bleeding risk. Trial sequential analysis assessment confirmed the superiority of thrombolytics for the primary outcome. Intracoronary GPI, either alone or combined with AT, did not improve procedural or clinical outcomes.
Compared with AT, intracoronary-administered thrombolytics significantly improved myocardial perfusion and MACE in STEMI patients.
This meta-analysis aimed to evaluate the effectiveness of intracoronary-administered thrombolytics or glycoprotein IIb/IIIa inhibitors (GPI) in comparison with aspiration thrombectomy (AT) as an adjunct to percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction (STEMI).
A comprehensive literature search for randomized trials that compared intracoronary-administered thrombolytics or GPI with AT in STEMI patients who underwent PCI, was conducted using various databases (e.g., MEDLINE, EMBASE, CENTRALE). Primary outcome was procedural measures (e.g., TIMI flow grade 3, TIMI myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3, ST-segment resolution (STR)).
Twelve randomized trials enrolled 1,466 patients: 696 were randomized to intracoronary-administered pharmacological interventions and 553 to AT. Patients randomized to PCI alone were excluded. Thrombolytics significantly improved TIMI flow grade 3 (odds ratio = 3.71, 95% CI: 1.85-7.45), complete STR (odds ratio = 3.64, 95% CI: 1.60-8.26), and TMPG 3 (odds ratio = 5.31, 95% CI: 2.48-11.36). Thrombolytics significantly reduced major adverse cardiovascular events (MACE) (odds ratio = 0.29, 95% CI: 0.13-0.65) without increasing bleeding risk. Trial sequential analysis assessment confirmed the superiority of thrombolytics for the primary outcome. Intracoronary GPI, either alone or combined with AT, did not improve procedural or clinical outcomes.
Compared with AT, intracoronary-administered thrombolytics significantly improved myocardial perfusion and MACE in STEMI patients.
摘要：
STEMI患者的血栓负荷在实践中仍然是一个挑战。加重冠状动脉阻塞导致心肌灌注受损，心脏功能恶化，和不良的临床结果。已经提倡各种策略来减少血栓负担。
本荟萃分析旨在评估冠状动脉内溶栓药物或糖蛋白IIb/IIIa抑制剂（GPI）与血栓抽吸术（AT）作为经皮冠状动脉介入治疗（PCI）的辅助手段在ST段抬高型心肌梗死（STEMI）患者中的有效性。
使用各种数据库对接受PCI的STEMI患者的冠状动脉内溶栓或GPI与AT进行比较的随机试验进行了全面的文献检索（例如，MEDLINE,EMBASE,CENTRALE).主要结果是程序性措施(例如，TIMI血流分级3级,TIMI心肌灌注分级(TMPG)3级,心肌腮红分级(MBG)2/3级,ST段分辨率(STR))。
12项随机试验纳入1,466例患者：696例随机接受冠状动脉内药物干预，553例随机接受AT。随机接受单独PCI的患者被排除。溶栓显著改善TIMI流量3级(比值比=3.71,95%CI:1.85-7.45),完全STR(比值比=3.64，95%CI：1.60-8.26)，和TMPG3（比值比=5.31，95%CI：2.48-11.36）。溶栓显著减少主要不良心血管事件（MACE）（比值比=0.29，95%CI：0.13-0.65），而不增加出血风险。试验序贯分析评估证实了溶栓药物对主要结局的优越性。冠状动脉内GPI,单独或与AT结合使用，未改善手术或临床结局.
与AT相比，冠状动脉内溶栓治疗可显著改善STEMI患者的心肌灌注和MACE.
本荟萃分析旨在评估冠状动脉内溶栓药物或糖蛋白IIb/IIIa抑制剂（GPI）与血栓抽吸术（AT）作为经皮冠状动脉介入治疗（PCI）的辅助手段在ST段抬高型心肌梗死（STEMI）患者中的有效性。
使用各种数据库对接受PCI的STEMI患者的冠状动脉内溶栓或GPI与AT进行比较的随机试验进行了全面的文献检索（例如，MEDLINE,EMBASE,CENTRALE).主要结果是程序性措施(例如，TIMI血流分级3级,TIMI心肌灌注分级(TMPG)3级,心肌腮红分级(MBG)2/3级,ST段分辨率(STR))。
12项随机试验纳入1,466例患者：696例随机接受冠状动脉内药物干预，553例随机接受AT。随机接受单独PCI的患者被排除。溶栓显著改善TIMI流量3级(比值比=3.71,95%CI:1.85-7.45),完全STR(比值比=3.64，95%CI：1.60-8.26)，和TMPG3（比值比=5.31，95%CI：2.48-11.36）。溶栓显著减少主要不良心血管事件（MACE）（比值比=0.29，95%CI：0.13-0.65），而不增加出血风险。试验序贯分析评估证实了溶栓药物对主要结局的优越性。冠状动脉内GPI,单独或与AT结合使用，未改善手术或临床结局.
与AT相比，冠状动脉内溶栓治疗可显著改善STEMI患者的心肌灌注和MACE.
