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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 infarction
Author(s) -
Rozenman Yoseph,
Mehran Roxana,
Witzenbichler Bernhard,
Dangas George,
Desaga Martin,
Kochman Janusz,
Nilsen Dennis W.,
Finkelstein Ariel,
Mosseri Morris,
Stone Gregg W.
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24279
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , activated clotting time , myocardial infarction , cardiology , bivalirudin , heparin
Objectives 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). Background UFH+GPI is commonly used during primary PCI for STEMI. UFH anticoagulation is titrated with ACT. Methods Patients randomized to UFH+GPI in HORIZONS‐AMI who underwent primary PCI are included ( N = 1,624). Initial UFH bolus was 60 IU kg −1 (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. Results Mortality at 30 days occurred in 2.2, 3.3, and 3.5% of patients in the low to high ACT tertiles, respectively ( P trend = 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%, P trend = 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], P < 0.001, for each 10 sec increase in ACT). Conclusions 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.