Efficacy of sonothrombolysis as an adjunct to primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: a systematic review and meta-analysis

TL;DR

This study finds that sonothrombolysis combined with a standard heart procedure improves heart function in patients with a severe type of heart attack.

Contribution

The study provides new evidence that sonothrombolysis improves left ventricular ejection fraction when used with primary percutaneous coronary intervention in STEMI patients.

Findings

Sonothrombolysis improved left ventricular ejection fraction compared to controls (MD = 3.07, p = 0.001).

No significant differences were found in infarction size or microvascular obstruction between groups.

The benefit in ejection fraction was not sustained after 2 to 6 months of follow-up.

Abstract

In this review, we aimed to evaluate Sonothrombolysis when combined with primary percutaneous coronary intervention (pPCI) in STEMI patients with regard to improving cardiac function and clinical outcomes. This study primarily assesses short-term efficacy outcomes, while long-term impacts, such as mortality, were not evaluated. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to November 2024. Four studies, with a total population of 252 participants, were included. The sonothrombolysis group demonstrated an overall greater improvement in left ventricular ejection fraction compared to the control group (MD = 3.07, 95% CI [1.20 to 4.94], p = 0.001), with no heterogeneity (p = 0.44, I2 = 0%). When subgrouped according to the follow-up period, there was no significant difference between the two groups (MD = 2.56, 95% CI [-0.35 to 5.46]) after 2 to 6 months. Infarction size, microvascular obstruction, left ventricular end-diastolic volume, and left ventricular end-systolic volume showed no statistically significant difference between the two groups. Sonothrombolysis following pPCI is associated with better left ventricular ejection fraction, emphasizing the potential role of sonothrombolysis as an adjunctive therapy to pPCI in the management of STEMI.

The online version contains supplementary material available at 10.1007/s11239-025-03176-1.

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