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ȣ - 530275 5 |
| Usefulness of routine post-procedure course of unfractionated heparin infusion following primary percutaneous coronary intervention for ST-elevation myocardial infarction in the drug-eluting stent era |
| 울산의대 강릉아산병원 |
| 유상용, 정상식, 신대희, 장진근, 이창근, 윤준영 |
Background and Objective: Optimal dose and duration of intravenous unfractionated heparin (UFH) infusion after primary PCI for STEMI is unknown when glycoprotein IIb/IIIa inhibitors (GPIs) are not used. We evaluated the utility of a routine post-procedure course of UFH following primary PCI for STEMI in patients not receiving GPIs, especially in the era of drug-eluting stent (DES). Methods: We studied 273 (216 men, 63 ± 12 years) consecutive patients who underwent primary PCI with DES implantation for STEMI between Dec 2003 and May 2009. All patients were received currently recommended loading and maintenance doses of aspirin and clopidogrel. Rates of in-hospital and cumulative 30-days major adverse cardiovascular events (MACEs) were compared between patients with brief (< 48 (26 ± 15) hours, Group 1) and prolonged (≥ 48 (83 ± 38) hours, Group 2) infusion of intravenous UFH following procedure. Results: The demographic and baseline angiographic characteristics were similar between 2 groups. Rates of in-hospital, cumulative 30-days MACEs and major bleeding events were not statistically different between groups (Table). Conclusion: In this single-center experience, in patients with STEMI who underwent primary PCI without GPIs in the era of DES, a routine post-procedure course of UFH infusion more than 48 hours was not associated with any significant benefits. Further study is warranted to determine the optimal duration and dose of administration of UFH infusion following primary PCI.
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In-Hospital events |
Cumulative 30-days events |
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Group 1 (n=89) |
Group 2 (n=184) |
p |
Group 1 (n=89) |
Group 2 (n=184) |
p |
|
CV death |
1.1 % (1) |
5.4 % (10) |
0.109 |
2.2 % (2) |
6.0 % (11) |
0.233 |
|
Subacute ST |
0.0 % (0) |
1.6 % (3) |
0.553 |
1.1 % (1) |
2.7 % (5) |
0.667 |
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Re-infarction |
0.0 % (0) |
1.6 % (3) |
0.553 |
1.1 % (1) |
2.2 % (4) |
0.128 |
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Ischemic-TVR |
0.0 % (0) |
0.5 % (1) |
1.000 |
0.0 % (0) |
1.1 % (2) |
1.000 |
|
Stroke |
1.1 % (1) |
1.1 % (2) |
1.000 |
1.1 % (1) |
1.1 % (2) |
1.000 |
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MACEs |
2.2 % (2) |
7.1 % (13) |
0.155 |
4.5 % (4) |
8.2 % (15) |
0.266 |
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Major bleeding |
1.1 % (1) |
2.2 % (4) |
1.000 |
1.1 % (1) |
2.7 % (5) |
0.667 |
CV= cardiovascular, MACEs=CV death, re-infarction including subacute ST, ischemic-TVR, or stroke, ST=stent thrombosis, TVR=target vessel revascularization.
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