Postprocedural Anticoagulation Decreases Mortality Rates After Primary PCI for STEMI

Postprocedural anticoagulation was associated with reduced mortality among patients with ST-elevation myocardial infarction (STEMI) who received primary percutaneous coronary intervention (pPCI). These findings were published in JACC: Cardiovascular Interventions.

The Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) study was a nationwide registry initiative which collected data from 159 tertiary and 82 secondary hospitals in China between 2014 and 2019. Outcomes were assessed on the basis of receiving postprocedural anticoagulation among patients (N=34,826) with STEMI who received pPCI. An inverse probability of treatment weighting approach was used to balance cohort differences.

Patients who did and did not receive postprocedural anticoagulation were aged mean 60.7±12.4 and 61.8±12.6 years (P <.001); 19.9% and 20.9% were women (P =.05); and 48.2% and 46.4% had hypertension (P <.001), respectively.

After weighting and adjusting, postprocedural anticoagulation was associated with decreased risk for death (adjusted hazard ratio [aHR], 0.62; 95% CI, 0.43-0.89) and cardiovascular death (aHR, 0.62; 95% CI, 0.43-0.90).

Among postprocedural anticoagulation recipients, the cumulative event rates were lower for mortality (P <.001), major adverse cardiovascular events (P <.001), and net adverse cardiovascular events (P =.0133) but not for major bleeding rates (P =.1359).

Stratified by major bleeding location and intervention, patients who received postprocedural anticoagulation had a decreased rate of retroperitoneal bleeding (0.0% vs 0.1%; P <.001) and increased rate of subcutaneous hemorrhage (0.3% vs 0.1%; P <.001).

In a subgroup analysis, postprocedural anticoagulation was favored among patients aged younger than 75 years, men, patients without hypertension, without diabetes, without high bleeding risk, current smokers, non-smokers, those with normal renal function, cardiogenic shock at admission, pPCI less than 12 hours after symptom onset, multivessel pPCI, and radial and non-radial access for the outcome of mortality.

For major bleeding, postprocedural anticoagulation was preferred among patients with multivessel pPCI and no postprocedural anticoagulation was preferred among patients with non-multivessel pPCI.

This study may have been limited by not having access to information about anticoagulant type or dosage.

“Among patients undergoing pPCI for STEMI in the CCC-ACS registry between 2014 and 2019, [postprocedural anticoagulation] was associated with a decreased risk of in-hospital mortality without increasing bleeding complications,” the study authors wrote. “Dedicated randomized studies are awaited to assess the value of [postprocedural anticoagulation] with modern anticoagulants.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Yan Y, Gong W, Ma C, et al. Postprocedure anticoagulation in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. JACC Cardiovasc Interv. Published online February 14, 2022. doi:10.1016/j.jcin.2021.11.035