Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents - 05/08/11

Doi : 10.1016/j.ahj.2009.12.041

Yong-Jian Li, MD ^a,^b, Seung-Woon Rha, MD ^a,^⁎ , Kang-Yin Chen, MD ^c, Kanhaiya L. Poddar, MD ^a, Zhe Jin, MD ^b, Yoshiyasu Minami, MD ^a, Lin Wang, MD ^a, Qun Dang, MD ^b, Guang-Ping Li, MD ^c, Sureshkumar Ramasamy, MD ^a, Ji-Young Park, MD ^a, Chol Ung Choi, MD ^a, Jin-Won Kim, MD ^a, Eung Ju Kim, MD ^a, Chang Gyu Park, MD ^a, Hong Seog Seo, MD ^a, Dong Joo Oh, MD ^a, Myung Ho Jeong, MD ^d, Young Keun Ahn, MD ^d, Taek Jong Hong, MD ^e, Jong-Seon Park, MD ^f, Young Jo Kim, MD ^f, Seung Ho Hur, MD ^g, In Whan Seong, MD ^h, Jei Keon Chae, MD ⁱ, Myeong Chan Cho, MD ^j, Jang Ho Bae, MD ^k, Dong Hoon Choi, MD ^l, Yang Soo Jang, MD ^l, In Ho Chae, MD ^m, Hyo Soo Kim, MD ⁿ, Chong Jin Kim, MD ^o, Jung Han Yoon, MD ^p, Tae Hoon Ahn, MD ^q, Seung-Jea Tahk, MD ^r, Wook Sung Chung, MD ^s, Ki Bae Seung, MD ^s, Seung Jung Park, MD ^t
other Korea Acute Myocardial infarction Registry Investigators^{^u}
See Appendix online.
^a Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
^b Cardiology Division, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
^c Cardiology Department, the Second Hospital of Tianjin Medical University, Tianjin, China
^d Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
^e Cardiovascular Center, Pusan National University Hospital, Pusan, Korea
^f Cardiovascular Center, Yeungnam University Hospital, Daegu, Korea
^g Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
^h Cardiovascular Center, Chungnam National University Hospital, Daejeon, Korea
ⁱ Cardiovascular Center, Chonbuk National University Hospital, Jeonju, Korea
^j Cardiovascular Center, Chungbuk National University Hospital, Chongju, Korea
^k Cardiovascular Center, Konyang University Hospital, Daejeon, Korea
^l Cardiovascular Center, Yonsei University Severance Hospital, Seoul, Korea
^m Cardiovascular Center, Seoul National University Bundang Hospital, Bundang, Korea
ⁿ Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
^o Cardiovascular Center, Kyung Hee University East-West Neo Medical Center, Seoul, Korea
^p Cardiovascular Center, Yonsei University Wonju Christian Hospital, Wonju, Korea
^q Cardiovascular Center, Gacheon University Gil Hospital, Seoul, Korea
^r Cardiovascular Center, Ajou University Hospital, Seoul, Korea
^s Cardiovascular Center, Seoul St. Mary’s Hospital, Seoul, Korea
^t Cardiovascular Center, Ulsan University Asan Medical Center, Seoul, Korea

^⁎Reprint requests: Seung-Woon Rha, MD, PhD, FACC, FAHA, FESC, FSCAI, FAPSIC, Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul 152-703, South Korea.

Résumé

Background

Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear.

Methods

A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared.

Results

The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95% CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95% CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95% CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex.

Conclusions

The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.

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Plan

Methods

Study population and antithrombotic regimens

PCI procedure and other medical treatment

Study definitions and clinical follow-up

Statistical analysis

Results

Discussion

Study strengths and limitations

Conclusions

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Vol 159 - N° 4

P. 684 - avril 2010 Retour au numéro

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Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents - 05/08/11

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