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AuthorKaddoura, Rasha
AuthorMohamed Ibrahim, Mohamed Izham
AuthorAl-Badriyeh, Daoud
AuthorOmar, Amr
AuthorAl-Kindi, Fahad
AuthorArabi, Abdul Rahman
Available date2023-05-28T08:39:06Z
Publication Date2022-05-05
Publication NamePLoS ONE
Identifierhttp://dx.doi.org/10.1371/journal.pone.0263270
CitationKaddoura, R., Mohamed Ibrahim, M. I., Al-Badriyeh, D., Omar, A., Al-Kindi, F., & Arabi, A. R. (2022). Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials. Plos one, 17(5), e0263270.
ISSN1932-6203
URIhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85129429866&origin=inward
URIhttp://hdl.handle.net/10576/43480
AbstractBackground 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. Objectives 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). Methods 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)). Results 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. Conclusions Compared with AT, intracoronary-administered thrombolytics significantly improved myocardial perfusion and MACE in STEMI patients.
SponsorThis article was funded by the Qatar National Library. (QNL).
Languageen
PublisherPublic Library of Science
SubjectPercutaneous Coronary Intervention
fibrinolytic agent
meta analysis
TitleIntracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials
TypeArticle
Issue Number5 May
Volume Number17
dc.accessType Open Access


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