Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents.
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.
Li
Yong-Jian
YJ
Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
Rha
Seung-Woon
SW
Chen
Kang-Yin
KY
Poddar
Kanhaiya L
KL
Jin
Zhe
Z
Minami
Yoshiyasu
Y
Wang
Lin
L
Dang
Qun
Q
Li
Guang-Ping
GP
Ramasamy
Sureshkumar
S
Park
Ji-Young
JY
Choi
Cheol Ung
CU
Choi
Chol Ung
CU
Kim
Jin-Won
JW
Kim
Eung Ju
EJ
Park
Chang Gyu
CG
Seo
Hong Seog
HS
Oh
Dong Joo
DJ
Jeong
Myung Ho
MH
Ahn
Young Keun
YK
Hong
Taek Jong
TJ
Park
Jong-Seon
JS
Kim
Young Jo
YJ
Hur
Seung Ho
SH
Seong
In Whan
IW
Chae
Jei Keon
JK
Cho
Myeong Chan
MC
Bae
Jang Ho
JH
Choi
Dong Hoon
DH
Jang
Yang Soo
YS
Chae
In Ho
IH
Kim
Hyo Soo
HS
Kim
Chong Jin
CJ
Yoon
Jung Han
JH
Ahn
Tae Hoon
TH
Tahk
Seung-Jea
SJ
Chung
Wook Sung
WS
Seung
Ki Bae
KB
Park
Seung Jung
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin