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. 2024 Jun 26;110(15):988–996. doi: 10.1136/heartjnl-2024-324078

Table 1.

Summary of studies investigating intracoronary thrombolysis for patients with STEMI

Study Year No of patients (N) Treatment arms Route of delivery Timing of delivery P2Y12 inhibitor GPIIb/IIIa inhibitor (%) Unfractionated heparin Thrombus aspiration (%) Follow-up
Sezer et al 25 2009 95
  • Streptokinase 250 kU

  • Nil

Guide catheter Post-stent Clopidogrel
  • 100

  • 100

100 U/kg NR 6 months
Zhao et al 18 2015 183
  • Urokinase 50 000–100 000 000 U

  • Stent implantation

Micro-catheter Post-thrombus aspiration, pre-stent Clopidogrel NR 8000–9000 U (additional 1000 U every 1 hour as required) NR 30 days
Greco et al 29 2013 102
  • Urokinase 200 000 U

  • Thrombus aspiration only

Micro-catheter Pre-stent Clopidogrel NR 100 U/kg NR 6 months
Geng et al 20 2018 230
  • Prourokinase 10 mg

  • Placebo

Punctured balloon catheter Post-balloon, pre-stent Ticagrelor NR 3000 U+70 U/kg for PCI NR 6 months
Xiao et al 28 2019 71
  • Prourokinase 10 mg

  • Thrombus aspiration

Micro-catheter Post-balloon, pre-stent Ticagrelor
  • 100

  • 100

50–70 U/kg
  • 0

  • 100

12 months
Fu et al 19 2019 39
  • Prourokinase 10–20 mg

  • Thrombus aspiration

Micro-catheter, child-in-mother catheter or pierced balloon Pre-stent Clopidogrel/ticagrelor NR NR
  • 0

  • 100

90 days
McCartney et al 24 2019 440
  • Alteplase 10 mg

  • Alteplase 20 mg

  • Placebo

Aspiration catheter or guide catheter if selectively engaged Post-balloon, pre-stent Clopidogrel/ticagrelor/prasugrel
  • 21

  • 16

  • 10

10 000 U
  • 32

  • 30

  • 27

3 months
Gibson et al 21 2020 36
  • Tenecteplase 4 mg

  • Placebo

Balloon catheter 1st dose: pre-balloon; 2nd dose: post-stent Clopidogrel
  • 84

  • 94

70 U/kg NR 30 days
Wang et al 26 2020 182
  • Prourokinase 20 mg

  • Placebo

Aspiration catheter Post-thrombus aspiration, pre-stent Ticagrelor
  • 18

  • 12

3000 U (additional dosage by ACT)
  • 100

  • 100

6 months
Wu et al 27 2020 50
  • Prourokinase 10 mg

  • Placebo

Aspiration catheter Post-thrombus aspiration, pre-stent Ticagrelor
  • 72

  • 56

5000 U (additional dosage guided by ACT)
  • 100

  • 100

3 months
Huang et al 22 2021 345
  • Prourokinase 20 mg

  • Tirofiban 10 µg/kg

  • Placebo

Intracoronary catheter Post-balloon or thrombus aspiration; pre-stent Clopidogrel/ticagrelor
  • 0

  • 100

  • 0

70–100 U/kg
  • 52

  • 50

  • 50

30 days
Jiang et al 23 2021 260
  • Prourokinase 10 mg

  • Placebo

Balloon catheter Post-balloon, pre-stent Ticagrelor NR 100 U/kg
  • 8

  • 6

6 months

ACT, activated clotting time; GPIIb/IIIa, glycoprotein IIb/IIIa; NR, not reported; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.