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
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