Abstract
BackroundThe optimal antithrombotic treatment during a primary percutaneous coronary intervention (pPCI) is not known. This single center registry study aims to assess the safety of a novel antithrombotic regimen combining enoxaparine and prasugrel at presentation, followed by bivalirudin at the catheterisation laboratory.MethodsAll consecutive patients who underwent a pPCI were collected prospectively. The primary endpoint was major bleeding within 30 days. The secondary endpoints were a composite of major adverse cardiovascular events (MACE) consisting of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, a new target vessel revascularisation and all-cause mortality at 30 days.ResultsNinety-nine out of the total of 390 patients were treated according to the new regimen (protocol-treated group). The rest received other antithrombotic treatment (non-protocol-treated group). The protocol-treated group had a lower risk than the non-protocol-treated group according to the GRACE ischaemic (112 vs. 124, p = 0.002) and CRUSADE bleeding scores (21 vs. 28, p < 0.0001). The incidences of bleeding were similar: severe GUSTO or TIMI bleeding occurred in 0 % of the protocol-treated group and in 1.0 and 0.3 %, respectively, of the other group (p = 0.311 for GUSTO and p = 0.559 for TIMI). The incidence of MACE in the groups was 6.1 and 10.7 %, respectively (p = 0.178). The respective incidences of all-cause mortality were 5.1 and 9.6 % (p = 0.158).ConclusionsAdministration of the novel antithrombotic regimen seems to be safe.
Highlights
Primary percutaneous coronary intervention is the preferred first-line treatment for acute ST- segment elevation myocardial infarction (STEMI) [1]
We report the results of our new antithrombotic Primary percutaneous coronary intervention (pPCI) regimen including aspirin, a low-dose enoxaparine i.v. bolus and prasugrel loading upon first medical contact (FMC) combined with a bivalirudin infusion initiated in the catheterisation laboratory
According to the new local STEMI guidelines launched on 1 November 2010, all acute STEMI patients referred to pPCI should receive aspirin 250 mg, enoxaparine 30 mg intravenously and prasugrel 60 mg upon FMC
Summary
Primary percutaneous coronary intervention (pPCI) is the preferred first-line treatment for acute ST- segment elevation myocardial infarction (STEMI) [1]. Antithrombotic treatment is an essential part of the pPCI procedure in enhancing the opening of the occluded coronary artery as well as preventing peri- and post-procedural thrombotic complications and late recurrent ischaemic events. Peri-procedural stroke, for example, has been recognised as an important life-limiting complication [2]. The application of clopidogrel and glycoprotein (GP) IIb/IIIa inhibitors in addition to heparin and aspirin has been shown to decrease early and late adverse cardiac events with a concomitant and undesired increase in bleeding events [3,4,5,6]. Bleeding has been recognised as a major determinant of cardiovascular death and adverse events in acute coronary syndrome (ACS) patients [7]
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