Intracoronary Low-Dose Thrombolysis in Primary PCI for STEM

Kevin R. Bainey, MD, MSc

The authors screened major databases (MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov) and identified four randomized controlled trials. pooled analyses showed no improvement in epicardial flow, myocardial perfusion, or clinical outcomes with adjunctive low‑dose intracoronary thrombolysis. Safety signals included a trend toward increased ventricular arrhythmias and bleeding. Subgroup analyses (e.g., alteplase‑based trials) did not alter the null findings. The review highlights the limited benefit of this strategy and underscores the need for alternative approaches to microvascular obstruction in STEMI.