Intracoronary Thrombolysis in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: an Updated Meta-analysis of Randomized Controlled Trials

Alexiou, Sophia; Patoulias, Dimitrios; Θεοδωρόπουλος, Κωνσταντίνος; Didagelos, Matthaios; Nasoufidou, Athina; Samaras, Athanasios; Ziakas, Antonios; Fragakis, Nikolaos; Dardiotis, Efthimios; Kassimis, George

doi:10.1007/s10557-022-07402-3

Cited by 7 publications

(5 citation statements)

References 35 publications

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“…This approach has been shown to be effective in patients undergoing primary PCI. A study found that IC administration of SK (250 kU over 3 minutes) improved "microvascular resistance", "collateral flow index", "mean coronary wedge pressure", "diastolic deceleration time" and coronary blood flow reserve two days after the process compared to a control group [51]. However, these improvements did not lead to better "left ventricular size" or function at six months.…”

Section: Intracoronary (Ic) Thrombo-lytic Therapymentioning

confidence: 99%

“…However, these improvements did not lead to better "left ventricular size" or function at six months. It is important to note that the research was not large enough to determine variations in clinical procedures or left ventricular function at six months [51]. Additionally, "IC TNK" is recognized to be an effective and safe treatment for managing thrombotic problems in "high-risk complex PCI" [52].…”

Section: Intracoronary (Ic) Thrombo-lytic Therapymentioning

confidence: 99%

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Role of Tissue Plasminogen Activators, Streptokinase and Other Thrombolytics in the Treatment of Myocardial Infarction

Eljatib¹

2023

JAMMR

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In the United States, coronary artery disease is the most frequently occurring cause of mortality. A century ago, the obstruction of CA was recognized as the root cause of myocardial infarction. Through research, streptokinase was discovered as a beneficial treatment for acute myocardial infarction, lowering mortality. More recent agents, such as tissue plasminogen activators like Tenecteplase, reteplase, and alteplase have also been developed. Today, primary percutaneous coronary intervention and thrombolytic therapy have transformed the way acute myocardial infarction is treated, leading to a significant decrease in cardiovascular-related deaths. This paper offers an outline of the different antifibrinolytic agents used to manage acute myocardial infarction.

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Section: Intracoronary (Ic) Thrombo-lytic Therapymentioning

confidence: 99%

Section: Intracoronary (Ic) Thrombo-lytic Therapymentioning

confidence: 99%

Role of Tissue Plasminogen Activators, Streptokinase and Other Thrombolytics in the Treatment of Myocardial Infarction

Eljatib¹

2023

JAMMR

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“…The effects of verapamil, diltiazem and nicardipine on no-reflow have been extensively investigated and well-documented [ 30 , 31 , 32 ]. A meta-analysis of 5 trials with a total of 325 participants randomized to receive verapamil/diltiazem (n = 162) or control therapy (n =163) demonstrated that intracoronary verapamil/diltiazem significantly decreased the occurrence of the coronary no reflow phenomenon (relative risk [RR]: 0.3, 95% CI: 0.16 to 0.57; p = 0.0002,

= 4%) [ 9 ]. In a retrospective analysis of 72 patients who received intracoronary nicardipine during PCI, no-reflow was successfully reversed with complete restoration of thrombolysis in myocardial infarction (TIMI) 3 flow in 71 of 72 patients (98.6%) [ 32 ].…”

Section: Current Management Of No-reflow Phenomenonmentioning

confidence: 99%

“…Furthermore, Alexiou et al . [ 9 ] conducted a meta-analysis, which demonstrated that intracoronary thrombolysis was associated with improved major adverse cardiac events and myocardial microcirculation in STEMI patients undergoing primary PCI. With this background, we will discuss standard pharmacologic options currently applied in the catheterization laboratory to treat no-reflow and highlight novel therapeutic options that have been the focus of several recent investigations.…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention

Pelliccia,

Niccoli,

Zimarino

et al. 2023

Rev. Cardiovasc. Med.

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Primary percutaneous coronary intervention (PCI) is the current class I therapeutic approach to treat acute ST-elevation myocardial infarction (STEMI). While primary PCI can restore adequate flow in the infarcted artery in the majority of cases, some patients experience the ‘no-reflow’ phenomenon, i.e., an abnormal myocardial reperfusion occurring even after the occluded coronary artery has been opened. No-reflow occurs when microvascular obstruction arises from embolization of thrombus or components of the atheromatous plaques. These embolic materials travel downstream within the infarct-related artery at time of primary PCI, leading to compromised blood flow. Currently, no expert consensus documents exist to outline an optimal strategy to prevent or treat no-reflow. Interventional cardiologists frequently employ intracoronary adenosine, calcium channel blockers, nicorandil, nitroprusside or glycoprotein IIb/IIIa inhibitors. However, evidence suggests that these interventions consistently enhance myocardial blood flow in only a specific subset of patients experiencing no-reflow. A recent and innovative therapeutic approach gaining attention is low-dose fibrinolysis during primary PCI, which offers the potential to augment coronary flow post-myocardial revascularization.

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“…Moreover, research suggests an 'acute and sub-acute ST rate' of approximately 2.5% in AMI patients. In specific cases like cardiac arrest and AMI, 'the incidence of early ST' within 30 days may rise to around 5% (1,2). Despite its efficacy, early coronary stent thrombosis can occur in up to 5% of STEMI patients with a successful first PCI procedure.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Early Stent Thrombosis (Acute and Subacute) in Patients Presenting With Acute St Elevation Myocardial Infarction (Stemi) Undergoing Primary Percutaneous Coronary Intervention (Pci)

KHAN,

ZEB,

ULLAH

et al. 2024

Biol Clin Sci Res J

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Sudden cardiac stent thrombosis (ST) is a severe clinical risk that can lead to high fatality rates. However, data are scarce on the prevalence of early ST events following ‘primary percutaneous coronary intervention’ (pPCI) and the characteristics that predict it, particularly among Pakistani patients. Objective: The objective is to determine possible indicators and evaluate ‘the frequency of acute and sub-acute stent thrombosis’ (ST) after ‘primary percutaneous coronary intervention’ (PCI). Methods: Five hundred individuals who had undergone primary PCI were enrolled from July 2022 to December 2023. Telephone follow-up assessments were used to gather information on 30-day results, including death rates, recurrence of symptoms, and episodes of ST. ‘ST was classified as acute’ (occurring ‘during the procedure’) or ‘sub-acute’ (‘occurring within 30 days post-procedure) using standardised criteria established by the ‘Academic Research Consortium. Results: In this study, 500 patients were enrolled, primarily male (80.4%, 362 patients). ‘Stent thrombosis’ (either acute or sub-acute) was observed in 6.8% of patients, with 10.1% (4) classified as definite ST and the remaining 91.9% (34) as probable ST. Male patients were more prevalent among those who developed ST, along with a higher incidence of hypertension, diabetes, reduced left ventricular ejection fraction (LVEF) pre-PCI, and higher Killip Class. Patients with ST experienced a higher in-hospital mortality rate compared to those without ST, with a p-value of 0.02. Notably, ‘Killip Class’ (‘III-IV’) emerged as ‘an independent ST predictor in this patient cohort. These findings underscore the importance of risk assessment and vigilant management, particularly in patients presenting with higher Killip Class and other associated risk factors, to mitigate ST occurrence and adverse outcomes following primary PCI. Conclusion: Early stent thrombosis (ST) appears relatively common in patients undergoing primary PCI. Those with diabetes and hypertension face an elevated risk of ST, while patients presenting in ‘Killip Class III-IV’ demonstrate an ‘independent predictive’ factor for early ST.

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Intracoronary Thrombolysis in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: an Updated Meta-analysis of Randomized Controlled Trials

Cited by 7 publications

References 35 publications

Role of Tissue Plasminogen Activators, Streptokinase and Other Thrombolytics in the Treatment of Myocardial Infarction

Role of Tissue Plasminogen Activators, Streptokinase and Other Thrombolytics in the Treatment of Myocardial Infarction

Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention

Frequency of Early Stent Thrombosis (Acute and Subacute) in Patients Presenting With Acute St Elevation Myocardial Infarction (Stemi) Undergoing Primary Percutaneous Coronary Intervention (Pci)

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