Intracoronary adjunctive therapies for ST-elevation myocardial infarction: a network meta-analysis of trials
Authors' conclusion
Adjunctive IC treatments during primary PCI do not influence hard clinical outcomes compared to conventional therapy within a mean 8-month follow-up, although several of them lead to an improvement in surrogate endpoints of CMVO.
Study context
- Population
- Patients with ST-elevation myocardial infarction (STEMI) receiving intra-coronary (IC) pharmacological and procedural treatments on top of balloon angioplasty and stent placement
- Participants
- 27,243 patients64 randomized controlled trials (RCTs)
- Comparison
- Adjunctive IC treatments during primary PCI compared to conventional primary PCI
- Outcome
- Primary efficacy endpoints: all-cause mortality, non-fatal myocardial infarction (MI), and heart failure (HF) hospitalization
- Follow-up
- Mean 8 months
Methodological detailsRCTs
- RCTs
Pooled result
As reported in the abstract
- No treatment significantly reduced the incidence of primary efficacy endpoints compared to conventional primary PCI
- Mixed comparisons
Further pooled results
| Outcome | Odds ratio (95% CI) | |
|---|---|---|
| Post-PCI TIMI 0-2 flow grade (secondary efficacy endpoint)Adenosinevs conventional primary PCI | 0.40 (0.24–0.68) | |
| Post-PCI TIMI 0-2 flow grade (secondary efficacy endpoint)Verapamilvs conventional primary PCI | 0.22 (0.07–0.69) | |
| Post-PCI TIMI 0-2 flow grade (secondary efficacy endpoint)Tirofibanvs conventional primary PCI | 0.43 (0.27–0.71) | |
| Post-PCI TIMI 0-2 flow grade (secondary efficacy endpoint)Manual thrombus aspiration (TA)vs conventional primary PCI | 0.61 (0.45–0.82) | |
| Post-PCI TIMI 0-2 flow grade (secondary efficacy endpoint)Fibrinolytic + manual TAvs conventional primary PCI | 0.24 (0.12–0.48) | |
| Post-PCI TIMI 0-2 flow grade (secondary efficacy endpoint)Tirofiban + manual TAvs conventional primary PCI | 0.32 (0.14–0.75) | |
| 0.050.21520Odds ratio (log scale) |
Safety
| Outcome | Estimate | |
|---|---|---|
| Any bleedingIC tirofibanvs conventional primary PCIIncreased risk | incidence rate ratio 1.65 (CI 1.11–2.45) | |
| Peri-procedural AVBsIC adenosinevs conventional primary PCIIncreased risk | OR 2.80 (CI 1.14–6.84) | |
| Peri-procedural VF/SVTNicorandilvs conventional primary PCIReduced incidence | OR 0.31 (CI 0.12–0.81) | |
| 0.10.31310Ratio (log scale) |
Original publication
Intracoronary adjunctive therapies for ST-elevation myocardial infarction: a network meta-analysis of trials. Eur Heart J Cardiovasc Pharmacother. Published 9 December 2025. doi:10.
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