Clinical outcomes of brief versus prolonged unfractionated heparin infusion after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the drug-eluting stent era: real-world, single-centre experience

Abstract

Objective Optimal dose and duration of intravenous unfractionated heparin (UFH) infusion after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) are unknown when glycoprotein IIb/IIIa inhibitors (GPIs) are not used. We evaluated the clinical outcomes in patients who received brief versus prolonged UFH infusion following primary PCI for STEMI in the era of drug-eluting stents (DES).Methods We studied 273 (216 men, 63 ± 12 years) consecutive patients who underwent primary PCI with DES implantation for STEMI between December 2003 and May 2009. All patients received currently recommended loading and maintenance doses of aspirin and clopidogrel. In-hospital and cumulative 30-day rates of major adverse cardiovascular events (MACEs) and major bleeding were compared between patients receiving brief (< 48 (26 ± 15) hours, group 1) and those receiving prolonged (≥ 48 (83 ± 38) hours, group 2) infusion of intravenous UFH following index procedure.Results The demographic and baseline angiographic characteristics were similar between the two groups. In-hospital and cumulative 30-day MACEs rates and major bleeding events rates were not statistically diff erent between groups.Conclusion In this single-centre experience, in patients with STEMI who underwent primary PCI in the era of DES, a routine post-procedure course of UFH infusion for more than 48 hours was not associated with any signifi cant benefi ts. Further study is warranted to determine the optimal duration and dose of administration of UFH infusion following primary PCI.