Department of Geriatric Cardiology, 159407The First Affiliated Hospital, China Medical University, Shenyang, China.
Angiology. 2021 Aug;72(7):679-686. doi: 10.1177/0003319721995039. Epub 2021 Feb 12.
The effects of intracoronary (IC) thrombolysis therapy in patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) remain unclear.
The meta-analysis was conducted according to the PRISMA statement. All relevant studies were identified by searching the PubMed, EMBASE, Cochrane Library, and Web of Science, with no time or language limitation. The pooled risk ratio (RR) and weighted mean difference (WMD) with a 95% CI were calculated.
Nine randomized controlled trials involving a total of 1341 patients were included. Compared with the control group, IC thrombolysis in patients with STEMI could reduce the incidence of major adverse cardiac events (MACE; RR 0.632, 95% CI, 0.474-0.843, = .002) and improve left ventricular ejection fraction (RR 0.343, 95% CI, 0.178-0.509, < .001) and myocardial microcirculation. However, there was no difference noted in the mortality (RR 0.759, 95% CI, 0.347-1.661, = .490). The incidence rate of major bleeding and minor bleeding was comparable between the 2 groups.
Intracoronary thrombolysis was associated with improved MACE and myocardial microcirculation in patients with STEMI having PPCI, though it failed to improve mortality.
在接受直接经皮冠状动脉介入治疗（PPCI）的 ST 段抬高型心肌梗死（STEMI）患者中，冠状动脉内溶栓治疗的效果仍不清楚。
该荟萃分析按照 PRISMA 声明进行。通过检索 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 数据库，无时间或语言限制，确定所有相关研究。计算合并的风险比（RR）和加权均数差（WMD）及其 95%置信区间（CI）。
共纳入 9 项随机对照试验，共纳入 1341 例患者。与对照组相比，STEMI 患者行冠状动脉内溶栓可降低主要不良心脏事件（MACE；RR 0.632，95%CI，0.474-0.843， =.002）和改善左心室射血分数（RR 0.343，95%CI，0.178-0.509， <.001）和心肌微循环。然而，两组间死亡率（RR 0.759，95%CI，0.347-1.661， =.490）无差异。两组间主要出血和轻微出血的发生率无差异。
在接受 PPCI 的 STEMI 患者中，冠状动脉内溶栓与改善 MACE 和心肌微循环相关，但不能改善死亡率。
