Relationship between the intensity of heparin anticoagulation and clinical outcomes in patients receiving glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention in acute myocardial infarction1. Issue 1 (17th April 2012)

• Record Type: Journal Article
• Authors: Rozenman, Yoseph; Mehran, Roxana; Witzenbichler, Bernhard; Dangas, George; Desaga, Martin; Kochman, Janusz; Nilsen, Dennis W.; Finkelstein, Ariel; Mosseri, Morris; Stone, Gregg W.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 81:Issue 1(2013:Jan. 01)
• Page Start: E9
• Page End: E14
• Publication Date: 2012-04-17
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24279
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Objectives</title> <p>We sought to determine the impact of the activated clotting time (ACT) in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with unfractionated heparin (UFH) and a glycoprotein IIb/IIIa inhibitor (GPI).</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Background</title> <p>UFH+GPI is commonly used during primary PCI for STEMI. UFH anticoagulation is titrated with ACT.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Methods</title> <p>Patients randomized to UFH+GPI in HORIZONS‐AMI who underwent primary PCI are included (<italic>N</italic> = 1, 624). Initial UFH bolus was 60 IU kg<sup>−1</sup> (target ACT: 200–250 sec). Patients were divided into three tertiles of peak ACT (cutoffs 240 and 298 sec). The 30‐day rates of major and minor bleeding, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE; MACE or major bleeding) were determined.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Results</title> <p>Mortality at 30 days occurred in 2.2, 3.3, and 3.5% of patients in the low to high ACT tertiles, respectively (<italic>P</italic><sub>trend</sub> = 0.22). Nor was the peak ACT significantly related to major bleeding, MACE or NACE. However, minor bleeding was increased in the highest ACT tertile (14.7% vs. 14.2% vs. 19.4%, <italic>P</italic><sub>trend</sub> = 0.04). By multivariable analysis peak ACT was not significantly related to major bleeding, mortality, MACE, and NACE but was a significant independent predictor of minor bleeding (odds ratio = 1.027 [1.013, 1.042], <italic>P</italic> < 0.001, for each 10 sec increase in ACT).</p> </sec> <sec id="abs1-5" sec-type="section"> <title>Conclusions</title> <p>In patients undergoing primary PCI for STEMI treated with UFH+GPI, the peak procedural ACT achieved does not have a substantial effect on major bleeding, mortality, or MACE, although lower peak ACT is associated with less minor bleeding. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>