| Institution: | 1. Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;2. Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China;3. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;4. Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA;5. Division of Cardiology, Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA;6. International Quality Improvement Department, American Heart Association, Dallas, Texas, USA;7. Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China;8. ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisière University Hospital, Paris, France;9. Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France |
| Abstract: | ObjectivesThis study sought to assess the association between postprocedural anticoagulation (PPAC) use and several clinical outcomes.BackgroundPPAC after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) may prevent recurrent ischemic events but may increase the risk of bleeding. No consensus has been reached on PPAC use.MethodsUsing data from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome registry, conducted between 2014 and 2019, we stratified all STEMI patients who underwent pPCI according to the use of PPAC or not. Inverse probability of treatment weighting and a Cox proportional hazards model with hospital as random effect were used to analyze differences in in-hospital clinical outcomes: the primary efficacy endpoint was mortality and the primary safety endpoint was major bleeding.ResultsOf 34,826 evaluable patients, 26,272 (75.4%) were treated with PPAC and were on average younger, more stable at admission with lower bleeding risk score, more likely to have comorbidities and multivessel disease, and more often treated within 12 hours of symptom onset than those without PPAC. After inverse probability of treatment weighting adjustment for baseline differences, PPAC was associated with significantly reduced risk of in-hospital mortality (0.9% vs 1.8%; HR: 0.62; 95% CI: 0.43-0.89; P < 0.001) and a nonsignificant difference in risk of in-hospital major bleeding (2.5% vs 2.2%; HR: 1.05; 95% CI: 0.83-1.32; P = 0.14).ConclusionsPPAC in STEMI patients after pPCI was associated with reduced mortality without increasing major bleeding complications. Dedicated randomized trials with contemporary STEMI management are needed to confirm these findings. |
