Efficacy of postprocedural anticoagulation after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Abstract

There exists controversy on whether and for how long anticoagulation is necessary after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).We aimed to study the impact of prolonged (>24 h) or brief (<24 h) postprocedural anticoagulation on infarct size assessed by cardiac magnetic resonance (CMR) after 30 days as well as on left ventricular ejection fraction (LVEF) and left ventricular (LV) remodeling evaluated by 2D-echocardiography after 9 months from the INNOVATION trial (Clinical Trial Registration: NCT02324348).Of the 114 patients (mean age: 59.5 years) enrolled, 76 (66.7%) received prolonged anticoagulation therapy (median duration: 72.6 h) and 38 (33.3%) patients received brief anticoagulation therapy (median duration: 5 h) after primary PCI. There was no significant difference in infarct size (mean size: 15.6% after prolonged anticoagulation versus 19.8% after brief anticoagulation, P = .100) and the incidence of microvascular obstruction (50.7% versus 52.9%, P = .830) between the groups. Even after adjusting, prolonged anticoagulation therapy could not reduce larger infarct (defined as >75 percentile of infarct size; 19.7% versus 35.3%; adjusted odd ratio [OR]: 0.435; 95% confidence interval [CI]: 0.120–1.57; P = .204). Similar results were observed in subanalyses of major high-risk subgroups. Moreover, follow-up LVEF <35% (3.2% versus 7.4%; adjusted OR: 0.383; 95% CI: 0.051–2.884; P = .352) and LV remodeling (defined as >20% increase in LV end-diastolic volume; 37.1% versus 18.5%; adjusted OR: 2.249; 95% CI: 0.593–8.535; P = .234) were similar between groups.These data suggest that prolonged postprocedural anticoagulation may not provide much benefit after successful primary PCI in patients with STEMI. However, further studies are needed.

Efficacy of Buqi Huoxue Decoction Combined with Cardiac Rehabilitation Nursing after Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction and Its Influence on Prognosis

“…The complications and quality of life cannot be effectively controlled, and the prognostic effect can be reduced. In order to reduce the damage to the myocardium, clinical treatment is often supplemented by western medicine [ 14 ], but the effect is not good.…”

Rationale of Anticoagulation Prolongation versus No Anticoagulation after Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

“…These findings suggest that routine AC for PE prophylaxis is unlikely to provide benefit after a successful, uncomplicated PPCI procedure with early ambulation. Song et al [21] found a slight, though not statistically significant, decrease in infarct size by CMR in the prolonged anticoagulation group compared to the brief anticoagulation group at 30 days post-PPCI.…”

The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly

“…Currently, multiple therapy options, including thrombolytic drugs, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting, are available to treat acute MI in clinic (Kahn et al, 1993;Sorensen and Maeng, 2015;Lhermusier et al, 2019;Song et al, 2019). In addition to medications and surgeries, epidemiological evidence has shown that exercise, such as stair climbing, walking, and sports, is inversely correlated to the mortality of cardiovascular causes (PaffenbargerJr., Hyde et al, 1986).…”