{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:19Z","timestamp":1787008699237,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This network meta-analysis of randomized controlled trials (RCTs) evaluates the comparative safety and efficacy of intra-coronary (IC) pharmacological and procedural treatments\u2014on top of balloon angioplasty and stent placement\u2014on clinical outcomes and surrogate endpoints of coronary microvascular obstruction (CMVO) in patients with ST-elevation myocardial infarction (STEMI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Two electronic databases were searched for eligible studies. Primary efficacy endpoints included all-cause mortality, non-fatal myocardial infarction (MI), and heart failure (HF) hospitalization. Primary safety endpoints included peri-procedural arrhythmias including atrioventricular blocks (AVBs) and ventricular fibrillation\/sustained ventricular tachycardia (VF\/SVT), any bleeding, and stroke. Secondary efficacy endpoints included the occurrence of post-procedural thrombolysis in myocardial infarction (TIMI) flow grade 0\u20132 and ST-segment resolution. A total of 64 RCTs involving 27 243 patients were included. In mixed comparisons, no treatment significantly reduced the incidence of primary efficacy endpoints compared to conventional primary PCI during a mean follow-up of 8 months. Several treatments significantly reduced the occurrence of post-PCI TIMI 0\u20132 flow grade [adenosine: 0.40 (odds ratio), (95% Confidence Interval 0.24\u20130.68); verapamil: 0.22 (0.07\u20130.69); tirofiban: 0.43 (0.27\u20130.71); manual thrombus aspiration (TA): 0.61 (0.45\u20130.82); fibrinolytic + manual TA: 0.24 (0.12\u20130.48); tirofiban + manual TA: 0.32 (0.14\u20130.75)], compared to conventional primary PCI. IC administration of tirofiban increased the risk of any bleeding [incidence rate ratio: 1.65 (1.11\u20132.45)], while IC adenosine increased the risk of peri-procedural AVBs [OR: 2.80 (1.14\u20136.84)]. Nicorandil reduced the incidence of peri-procedural VF\/SVT [OR: 0.31 (0.12\u20130.81)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study registration number<\/jats:title>\n                    <jats:p>CRD42023468559<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvaf085","type":"journal-article","created":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T12:46:30Z","timestamp":1765111590000},"page":"25-34","source":"Crossref","is-referenced-by-count":2,"title":["Intracoronary adjunctive therapies for ST-elevation myocardial infarction: a network meta-analysis of trials"],"prefix":"10.1093","volume":"12","author":[{"given":"Renzo","family":"Laborante","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Science, Fondazione Policlinico Agostino Gemelli IRCCS , Rome ,","place":["Italy"]},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset"},{"name":"Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiliano","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Science, Fondazione Policlinico Agostino Gemelli IRCCS , Rome ,","place":["Italy"]},{"name":"Department of Cardiology, National University of Ireland Galway (NUIG) , Galway ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Ciliberti","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Science, Fondazione 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Cardiovascular Science, Fondazione Policlinico Agostino Gemelli IRCCS , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Galli","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome , Latina ,","place":["Italy"]},{"name":"GVM Care & Research, Maria Cecilia Hospital , Cotignola ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Biondi-Zoccai","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome , Latina ,","place":["Italy"]},{"name":"GVM Care & Research, Maria Cecilia Hospital , Cotignola ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W","family":"Serruys","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset"},{"name":"CORRIB Research Centre for Advanced Imaging and Core Laboratory , Galway ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9404-8846","authenticated-orcid":false,"given":"Filippo","family":"Crea","sequence":"additional","affiliation":[{"name":"Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina-Gemelli Isola , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5404-3968","authenticated-orcid":false,"given":"Giuseppe","family":"Patti","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale , Novara ,","place":["Italy"]},{"name":"Division of Cardiology, AOU Maggiore della Carit\u00e0 , Novara 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