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ȣ - 510905 51 |
| Safety and Efficacy of Low Molecular Weight Heparin, Unfractionated Heparin or Both Combination Therapy in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention |
| 고려대학교 구로병원 순환기 내과¹ ,전남대학교 순환기 내과² |
| Kang-yin Chen¹, 나승운¹ ,Zhe Jin¹, Yoshiyasu Minami¹ ,나진오¹ ,서순용¹ ,최철웅¹ ,김진원¹ ,김응주¹ ,박창규¹ ,서홍석¹ ,오동주¹ ,정명호² |
Background:Efficacy and safety of LMWH only,UFH only or combination of these two antithrombotics in pts with AMI undergoing primary PCI is controversial.
Method:3,073 AMI pts from KAMIR were enrolled.All pts were assigned to receive one of following regimens:LMWH(60mg IV or SC bid for 5-7 days) or UFH(5,000 U IV bolus, followed by 24,000 U/day for 2days) or combination therapy.Bleeding and clinical outcomes were compared.Result:Three groups did not differ in baseline characteristics and also had no significant difference in cardiac death,in-hospital bleeding events.Combination group showed lower in-hospital death and trend toward lower mortality up to 6 months.All MACE was also lower in combination group up to one month but was not maintained up to 6 months (Table).Conclusion:Although LMWH,UFH and both combination therapy had similar in-hospital safety profiles, combination therapy lowered incidences of early mortality and all MACE but these effects were not well maintained throughout the followm up period.
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Table: In-hospital, 1
month and 6 months clinical outcomes
|
Variable,
n (%) |
LMWH(n=687) |
UFH(n=1695) |
Combination(n=691) |
P
value |
|
In-hospital |
? |
? |
? |
? |
|
Total
death |
19
(2.8) |
52
(3.1) |
7
(1.0) |
0.014 |
|
Revascularization
|
10
(1.5) |
33
(1.9) |
10
(1.4) |
0.577 |
|
All
MACE |
32
(4.7) |
93
(5.5) |
17
(2.5) |
0.006 |
|
TIMI-major
bleeding |
0
(0) |
8
(0.5) |
5
(0.7) |
0.106 |
|
At 1 month |
? |
? |
? |
? |
|
Total
death |
22
(3.4) |
56
(3.5) |
11
(1.6) |
0.057 |
|
Revascularization |
12
(1.8) |
42
(2.6) |
13
(1.9) |
0.425 |
|
??All MACE |
39
(5.8) |
113
(6.9) |
26
(3.8) |
0.017 |
|
At 6
months |
? |
? |
? |
? |
|
Total
death |
24
(3.6) |
60
(3.7) |
12
(1.8) |
0.051 |
|
Revascularization |
28
(4.2) |
74
(4.5) |
54
(7.9) |
0.001 |
|
All
MACE |
58
(8.7) |
154
(9.4) |
69
(10.1) |
0.669 |
|
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