دورية أكاديمية
Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials
| العنوان: | Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials |
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| المؤلفون: | Rasha Kaddoura, Mohamed Izham Mohamed Ibrahim, Daoud Al-Badriyeh, Amr Omar, Fahad Al-Kindi, Abdul Rahman Arabi |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Biomedical and clinical sciences, Cardiovascular medicine and haematology, Pharmacology and pharmaceutical sciences, ST-segment elevation myocardial infarction (STEMI), Acute myocardial infarction, Thrombosis, Coronary vessel occlusion, Percutaneous coronary intervention (PCI), Thrombolysis, Left ventricular remodeling, Congestive heart failure, Mortality risk, Intracoronary thrombus burden, Aspiration thrombectomy (AT), Myocardial blush grade (MBG), ST-segment resolution (STR), Microvascular obstruction (MVO), Major adverse cardiovascular events (MACE), Glycoprotein IIb/IIIa inhibitors (GPI), Fibrinolytic agents, Thrombus dissolution |
| الوصف: | Background 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. Other Information Published in: PLOS ONE License: http://creativecommons.org/licenses/by/4.0Test/ See article on ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | unknown |
| العلاقة: | https://figshare.com/articles/journal_contribution/Intracoronary_pharmacological_therapy_versus_aspiration_thrombectomy_in_STEMI_IPAT-STEMI_A_systematic_review_and_meta-analysis_of_randomized_trials/25257229Test |
| DOI: | 10.1371/journal.pone.0263270 |
| الإتاحة: | https://doi.org/10.1371/journal.pone.0263270Test https://figshare.com/articles/journal_contribution/Intracoronary_pharmacological_therapy_versus_aspiration_thrombectomy_in_STEMI_IPAT-STEMI_A_systematic_review_and_meta-analysis_of_randomized_trials/25257229Test |
| حقوق: | CC BY 4.0 |
| رقم الانضمام: | edsbas.8A6C96CA |
| قاعدة البيانات: | BASE |
| DOI: | 10.1371/journal.pone.0263270 |
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