Intravenous thrombolysis before percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome and acute ischaemic stroke: a subanalysis of the PRAISE study

Sedghi A, Von Rennenberg R, Petzold G, Nickenig G, Kallmünzer B, Achenbach S, Huber R, Seeger J, Von Sarnowski B, Thomalla G, Ringleb PA, Michalski D, Laufs U, Royl G, Szabo K, Mangner N, Puetz V, Kellert L, Kaeaeb S, Wunderlich S, Laugwitz KL, Petersen M, Mengel A, Leistner DM, Landmesser U, Endres M, Nolte CH, Siepmann T (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 12

Article Number: e003567

Journal Issue: 2

DOI: 10.1136/openhrt-2025-003567

Abstract

Background In patients with acute ischaemic stroke (AIS) and concomitant non-ST-elevation acute coronary syndrome (NSTE-ACS), the role of intravenous thrombolysis (IVT) before percutaneous coronary intervention (PCI) is unclear. Methods We performed a subanalysis of the PRAISE (PRediction of Acute coronary syndrome in acute Ischemic StrokE) study, a multicentre, prospective observational study in 247 patients with AIS and elevated high-sensitivity cardiac troponin who underwent coronary angiography based on European Society of Cardiology guidelines. The impact of IVT prior to PCI on coronary artery flow (Thrombolysis in Myocardial Infarction (TIMI) score) and myocardial perfusion (TIMI myocardial perfusion score) was compared using Fisher’s exact test and logistic regression analysis, adjusting for time from stroke onset to PCI. Results Among 71 patients with AIS undergoing PCI, those who received IVT prior to PCI for NSTE-ACS (33 women; median age 77 (66–82 IQR)) achieved a TIMI grade 3 flow more frequently than those undergoing direct PCI (97% vs 79%; p=0.04). Regression analysis indicated a trend toward improved coronary artery flow with IVT (adjusted OR 8.5, 95% CI 0.9 to 75.3; p=0.05). Myocardial perfusion did not differ between groups (p=0.06). Conclusions This subanalysis suggests that IVT before PCI may enhance coronary artery flow in selected patients with NSTE-ACS with AIS. The results of this exploratory subanalysis warrant further investigation, particularly in patients with delayed access to PCI.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Klinikum der Universität München (LMU Klinikum) Germany (DE) Klinikum rechts der Isar Germany (DE) Technische Universität München (TUM) Germany (DE) Klinikum Osnabrück Germany (DE) Eberhard Karls Universität Tübingen Germany (DE) Goethe-Universität Frankfurt am Main Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Universitätsklinikum Bonn Germany (DE) Medizin Campus Bodensee Germany (DE) Universitätsmedizin Greifswald / Universitätsklinikum Greifswald Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Universitätsklinikum Leipzig Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Hochschule Mannheim University of Applied Sciences Germany (DE)

How to cite

APA:

Sedghi, A., Von Rennenberg, R., Petzold, G., Nickenig, G., Kallmünzer, B., Achenbach, S.,... Siepmann, T. (2025). Intravenous thrombolysis before percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome and acute ischaemic stroke: a subanalysis of the PRAISE study. Open Heart, 12(2). https://doi.org/10.1136/openhrt-2025-003567

MLA:

Sedghi, Annahita, et al. "Intravenous thrombolysis before percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome and acute ischaemic stroke: a subanalysis of the PRAISE study." Open Heart 12.2 (2025).

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