title: Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents.
abstract: 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.
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Li
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Kang-Yin
authors.initials: KY
authors.lastname: Chen
authors.forename: Kanhaiya L
authors.initials: KL
authors.lastname: Poddar
authors.forename: Zhe
authors.initials: Z
authors.lastname: Jin
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Qun
authors.initials: Q
authors.lastname: Dang
authors.forename: Guang-Ping
authors.initials: GP
authors.lastname: Li
authors.forename: Sureshkumar
authors.initials: S
authors.lastname: Ramasamy
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Park
authors.forename: Cheol Ung
authors.initials: CU
authors.lastname: Choi
authors.forename: Chol Ung
authors.initials: CU
authors.lastname: Choi
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Eung Ju
authors.initials: EJ
authors.lastname: Kim
authors.forename: Chang Gyu
authors.initials: CG
authors.lastname: Park
authors.forename: Hong Seog
authors.initials: HS
authors.lastname: Seo
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Ahn
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Choi
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Jang
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Hyo Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Ahn
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin