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Anticoagulation strategies in ST-segment elevation myocardial infarction: insights from a national registry
Session:
CO 05 - Isquemia/SCA
Speaker:
Sofia Alegria
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sofia Alegria; Helder Pereira; P. Carrilho Ferreira; Rita Calé; Pedro Canas Da Silva; Filipe Seixo; João Costa; Rui Cruz Ferreira; Rui Campante Teles; Renato Fernandes; Vasco Gama Ribeiro; João Luís Pipa; Francisco Pereira Machado; E. Infante de Oliveira; GRAÇA SILVA; José Baptista; Henrique Cyrne Carvalho; Pedro Farto e Abreu; João Calisto; Dinis Martins; Marco Costa; JOAO SILVA; José Palos; Luis Bernardes; Paulino Sousa; Víctor Brandão; Em nome dos Investigadores do Registo Nacional de Cardiologia de Intervenção-PCI
Abstract
<p>Introduction: Despite several clinical trials, there is still controversy regarding the best strategy for parenteral anticoagulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), with significant differences between guidelines and clinical practice in most centers.</p> <p>Purpose: To evaluate the impact on mortality of the different strategies of parenteral anticoagulation in patients with STEMI submitted to PPCI, included in the Portuguese Registry of Interventional Cardiology (PRIC).</p> <p>Methods: Retrospective observational study of patients with STEMI undergoing PPCI between 2012 and 2016 included in the PRIC. The strategies of parenteral anticoagulation were evaluated and their association with in-hospital, 30-day and 1-year mortality was analyzed.</p> <p>Results: Among the 66068 PCI inserted in the PRIC, 15208 (23.0%) were PPCI performed in patients with STEMI. Unfractionated heparin (UFH) was used in 69.2% procedures, and low-molecular-weight heparin (LMWH) in 3.1%. In the remaining cases both UFH and LMWH were administered, no anticoagulant was used or there was no information. According to this registry there was no use of bivalirudin. We documented a significant increase in the use of UFH between 2012 and 2016 (94.2% <em>vs </em>98.2%, p <0.001).</p> <p>The two groups did not differ significantly in terms of age, sex, body mass index, history of acute myocardial infarction, heart failure or myocardial revascularization surgery, number of vessels or segments with lesions ≥ 50%, or prevalence of multivessel disease.</p> <p>The use of glycoprotein IIb-IIIa inhibitors (GPI) was more common in the LMWH group (21.3% <em>vs</em> 31.4%, p < 0.001). The use of radial or femoral arterial access was similar in both groups, however, there was more use of alternative accesses (namely brachial access) in the LMWH group (5.7% <em>vs</em> 10.8%, p < 0.001).</p> <p>According to the data available in the PRIC, in-hospital and 30-day mortality was 1.6% and at 1 year was 1.9%. Major bleeding after PPCI occurred in 0.1% of cases. There were no significant differences between the two groups regarding mortality or bleeding.</p> <p>The impact on mortality of the arterial access and the use of GPI was different according to the anticoagulation strategy selected. In fact, there was a significant increase in 30-day mortality in the UFH group with the use of femoral access (3.1 vs 0.8%; p < 0.001) and GPI (2.2 vs. 1.5%; p = 0.033), but not in the LMWH group.</p> <p>Conclusions: This study reflects the national reality in the use of parenteral anticoagulation in PPCI in the setting of STEMI, with predominant use of UFH and no use of bivalirudin. The different anticoagulation strategies were not associated with differences in mortality in the short or long term in the overall population, although the use of femoral access and GPI increased short-term mortality in patients treated with UFH.</p>
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