A-44 | Outcomes of CABG versus High-Risk PCI in Triple/Quadruple Vessel Coronary Artery Disease During Acute Myocardial Infarction: A Contemporary Analysis of 45,850 Patients

Background: Sonothrombolysis, an innovative technique combining ultrasound and microbubbles to enhance clot dissolution, has emerged as a potential adjuvant therapy to percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI).This meta-analysis evaluates the efficacy of sonothrombolysis compared to PCI alone in improving key clinical and imaging outcomes in AMI patients.Methods: A systematic search was conducted in PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.govusing predefined keywords for studies published up to September 2024.Dichotomous outcomes were pooled as risk ratios (RR), and continuous outcomes as mean differences (MD) with 95% confidence intervals (CI) using a random-effects model.Heterogeneity was assessed using I 2 and Chisquared (X 2 ) statistics, with I 2 >50% indicating significant heterogeneity.Statistical analyses were performed in RevMan 5.4, with p<0.05 considered significant.Results: This meta-analysis included seven randomized controlled trials, encompassing 528 patients with AMI with a mean age of 59.99 years.Sonothrombolysis demonstrated significant efficacy in achieving complete ST-segment resolution (RR 2.69, 95% CI 1.06-6.82)and reducing infarct size in percentage (MD -4.27%, 95% CI -6.52 to -2.02) and in grams (MD -7.73g, 95% CI -14.89 to -0.57).No significant differences were observed in partial ST-segment resolution (RR 1.77, 95% CI 0.55-5.73)or LVEF at 48-72 hours (MD 2.94, 95% CI -3.86 to 9.75), 1 month (MD 2.18, 95% CI -4.30 to 8.67), and 6 months (MD 3.44, 95% CI -2.08 to 8.97).TIMI flow grade 3 (RR 1.11, 95% CI 0.79-1.57),troponin peak (MD -3.35, 95% CI -9.73 to 3.03), and CK peak (MD -30.66, 95% CI-67.13 to 5.80) also showed no significant differences.Conclusions: Sonothrombolysis as an adjuvant to PCI demonstrated superior efficacy in achieving complete ST-segment resolution and reducing infarct size compared to PCI alone in patients with AMI.However, no significant improvement was observed in LVEF, TIMI flow grade 3, or biomarker concentrations.Small sample sizes and interstudy heterogeneity undermine our findings.Further large-scale RCTs are warranted to establish conclusive evidence.