Upstream anticoagulation for patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the TOTAL trial
Autor: | Raul Moreno, Asim N. Cheema, Vladimír Džavík, Madhu K. Natarajan, Anthony Della Siega, John A. Cairns, Warren J. Cantor, Goran Stankovic, Sanjit S. Jolly, Fei Yuan, Sasko Kedev, Yaniv Levi, Shahar Lavi |
---|---|
Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual medicine.drug_class medicine.medical_treatment Shock Cardiogenic Infarction 030204 cardiovascular system & hematology Coronary Angiography Risk Assessment Drug Administration Schedule 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Recurrence Risk Factors Internal medicine medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases 030212 general & internal medicine Myocardial infarction Thrombus Stroke Aged Randomized Controlled Trials as Topic Heart Failure business.industry Cardiogenic shock Anticoagulant Percutaneous coronary intervention Anticoagulants General Medicine Middle Aged medicine.disease 3. Good health surgical procedures operative Treatment Outcome Conventional PCI Cardiology ST Elevation Myocardial Infarction Administration Intravenous Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventionsREFERENCES. 96(3) |
ISSN: | 1522-726X |
Popis: | Objectives To assess the relationship between preprocedural anticoagulation use and clinical and angiographic outcomes. Background For patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), the optimal timing of anticoagulant administration remains uncertain. Methods Patients enrolled in the TOTAL trial were stratified based on whether or not they had received any parenteral anticoagulant prior to randomization and PCI. Baseline and procedural characteristics were compared. For one-year clinical outcomes, Cox proportional modeling adjusted on a propensity score was used to analyze differences between groups. Angiographic endpoints were analyzed by logistic regression models adjusted for propensity scores. Results In the trial, 10,064 patients were enrolled and underwent PCI. Preprocedural anticoagulation was used in 6,381 patients (63%).The most common anticoagulant was intravenous unfractionated heparin (5,188, 81%). Patients who received preprocedural anticoagulation had higher rates of TIMI-2-3 or TIMI-3 flow and lower grades of thrombus prior to PCI. Pretreatment with anticoagulation was associated with lower use of bailout thrombectomy, GP IIb/IIIa inhibitors, and intra-aortic balloon pump. After adjustment, preprocedural anticoagulation was associated with lower rates of CABG and minor bleeding at 1 year but there were no significant differences in death, stroke, recurrent MI, cardiogenic shock, or congestive heart failure. Conclusions Preprocedural anticoagulation is associated with improved flow and reduced thrombus in the IRA prior to PCI, less bailout thrombectomy during PCI but no difference in death, recurrent infarction, or heart failure at 1 year. |
Databáze: | OpenAIRE |
Externí odkaz: |