Cardiology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Cardiology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Heart Lung Circ. 2021 Aug;30(8):1140-1150. doi: 10.1016/j.hlc.2021.02.016. Epub 2021 Mar 27.
Despite routinely restoring epicardial coronary patency, with primary percutaneous coronary intervention (PCI), microvascular obstruction affects approximately half of patients and confers an adverse prognosis. There are no evidence-based treatments for microvascular obstruction. A key contributor to microvascular obstruction is distal embolisation and microvascular thrombi. Adjunctive intracoronary fibrinolytic therapy may reduce thrombotic burden, potentially reducing distal embolisation of atherothrombotic debris to the microcirculation. In this review, the evidence from published randomised trials on the effects of adjunctive intracoronary fibrinolytic therapy during primary PCI is critically appraised, the ongoing randomised trials are described, and conclusions are made from the available evidence. Clinical uncertainties, to be addressed by future research, are highlighted.
尽管经皮冠状动脉介入治疗（PCI）能常规恢复心外膜冠状动脉通畅，但仍有约一半的患者会发生微血管阻塞，且预后不良。目前尚无针对微血管阻塞的循证治疗方法。微血管阻塞的一个关键因素是远端栓塞和微血管血栓形成。辅助性冠状动脉内溶栓治疗可能会降低血栓负荷，从而减少动脉粥样硬化血栓碎片向微循环的远端栓塞。在这篇综述中，我们批判性地评估了已发表的随机试验中关于在直接 PCI 中辅助性冠状动脉内溶栓治疗效果的证据，描述了正在进行的随机试验，并根据现有证据得出结论。还强调了临床中的不确定因素，这些问题将有待未来的研究来解决。
