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

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Abstract

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 (Ptrend = 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%,Ptrend = 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.

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