Feasibility of Low-Molecular-Weight-Heparin (Fraxiparine) for Primary Stenting in Acute Myocardial Infarction

Abstract

Background and objectives:The optimal anti-thrombotic strategy for primary stenting in acute myocardial infarction (AMI) is still controversial. We evaluated prospectively the efficacy and safety of low-molecularweight-heparin (LMWH) for primary stenting in AMI. Materials and Method:From 1/1997 to 7/1998, 54 AMI pts underwent primary stenting with 96% of procedural success rate (52/54). Of these, five pts were excluded from the study for warfarinization or use of GPIIb/IIIa inhibitor despite of successful stenting (TIMI 3 flow and less than 30% of residual stenosis). In 47 pts included in the study, 5,000-10,000 U of unfractionated heparin was administered (IV/bolus) bofore primary stenting. After sheath removal, LMWH (Fraxiparine, 7500 U/S.C.BID) maintained for 10.6±5.7 days. Aspirin and ticlopidine (500mg/day for ≥4 weeks) were given before stenting. Pts were followed to determine early (0-30 days) and late (31-180 days) major adverse cardiac events (MACE). Subsequent revascularization involving other coronary arteries did not constitute an end point. Results:In 47 Pts (M:F=32:15, age=57.7±11.3 yrs, range:37-88), 50 stents (Nir:38, micro:7, Jo:5, LAD:LCX:RCA=24:9:14) were implanted. Their immediate poststenting MLD and diameter-stenosis (%) were 2.9±0.4 mm, 4.3±8.7%, respectively. No patient showed subacute stent thrombosis or major bleeding requiring blood transfusion or surgery. During 0-30 days, the primary combined end point occurred in 2 (4.2%):one repeated angioplasty for in-stent restenosis;one hospital death for pump failure (1 of 2 Killip IV pts at admission). 44 patients were followed for 180 days and additional three TVR (3/44 (6.8%), one CABG, one repeatedangioplasty and one recurrrent myocardial infarction) occurred between 30-180 days due to recurrent ischemia. Conclusion:Anti-thrombotic therapy with LMWH (Fraxiparine) is safe and feasible for primary stenting in AMI. But to illuminate the impact on 논문접수일:1999년 3월 7일 심사완료일:1999년 6월 2일 교신저자:오동주, 152-703 서울 구로구 구로동 고려대학교 의과대학 순환기내과학교실 전화:(02) 818-6633·전송:(02) 866-1643 E-mail:hhansin@unitel.co.kr