American Heart Journal
Volume 159, Issue 4 , Pages 684-690.e1, April 2010

Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents

  • Yong-Jian Li, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • Cardiology Division, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
    • ,
  • Seung-Woon Rha, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • Corresponding Author InformationReprint requests: Seung-Woon Rha, MD, PhD, FACC, FAHA, FESC, FSCAI, FAPSIC, Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul 152-703, South Korea.
    • ,
  • Kang-Yin Chen, MD

      Affiliations

    • Cardiology Department, the Second Hospital of Tianjin Medical University, Tianjin, China
    • ,
  • Kanhaiya L. Poddar, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Zhe Jin, MD

      Affiliations

    • Cardiology Division, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
    • ,
  • Yoshiyasu Minami, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Lin Wang, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Qun Dang, MD

      Affiliations

    • Cardiology Division, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
    • ,
  • Guang-Ping Li, MD

      Affiliations

    • Cardiology Department, the Second Hospital of Tianjin Medical University, Tianjin, China
    • ,
  • Sureshkumar Ramasamy, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Ji-Young Park, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Chol Ung Choi, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Jin-Won Kim, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Eung Ju Kim, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Chang Gyu Park, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Hong Seog Seo, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Dong Joo Oh, MD

      Affiliations

    • Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
    • ,
  • Myung Ho Jeong, MD

      Affiliations

    • Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
    • ,
  • Young Keun Ahn, MD

      Affiliations

    • Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
    • ,
  • Taek Jong Hong, MD

      Affiliations

    • Cardiovascular Center, Pusan National University Hospital, Pusan, Korea
    • ,
  • Jong-Seon Park, MD

      Affiliations

    • Cardiovascular Center, Yeungnam University Hospital, Daegu, Korea
    • ,
  • Young Jo Kim, MD

      Affiliations

    • Cardiovascular Center, Yeungnam University Hospital, Daegu, Korea
    • ,
  • Seung Ho Hur, MD

      Affiliations

    • Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
    • ,
  • In Whan Seong, MD

      Affiliations

    • Cardiovascular Center, Chungnam National University Hospital, Daejeon, Korea
    • ,
  • Jei Keon Chae, MD

      Affiliations

    • Cardiovascular Center, Chonbuk National University Hospital, Jeonju, Korea
    • ,
  • Myeong Chan Cho, MD

      Affiliations

    • Cardiovascular Center, Chungbuk National University Hospital, Chongju, Korea
    • ,
  • Jang Ho Bae, MD

      Affiliations

    • Cardiovascular Center, Konyang University Hospital, Daejeon, Korea
    • ,
  • Dong Hoon Choi, MD

      Affiliations

    • Cardiovascular Center, Yonsei University Severance Hospital, Seoul, Korea
    • ,
  • Yang Soo Jang, MD

      Affiliations

    • Cardiovascular Center, Yonsei University Severance Hospital, Seoul, Korea
    • ,
  • In Ho Chae, MD

      Affiliations

    • Cardiovascular Center, Seoul National University Bundang Hospital, Bundang, Korea
    • ,
  • Hyo Soo Kim, MD

      Affiliations

    • Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
    • ,
  • Chong Jin Kim, MD

      Affiliations

    • Cardiovascular Center, Kyung Hee University East-West Neo Medical Center, Seoul, Korea
    • ,
  • Jung Han Yoon, MD

      Affiliations

    • Cardiovascular Center, Yonsei University Wonju Christian Hospital, Wonju, Korea
    • ,
  • Tae Hoon Ahn, MD

      Affiliations

    • Cardiovascular Center, Gacheon University Gil Hospital, Seoul, Korea
    • ,
  • Seung-Jea Tahk, MD

      Affiliations

    • Cardiovascular Center, Ajou University Hospital, Seoul, Korea
    • ,
  • Wook Sung Chung, MD

      Affiliations

    • Cardiovascular Center, Seoul St. Mary’s Hospital, Seoul, Korea
    • ,
  • Ki Bae Seung, MD

      Affiliations

    • Cardiovascular Center, Seoul St. Mary’s Hospital, Seoul, Korea
    • ,
  • Seung Jung Park, MD

      Affiliations

    • Cardiovascular Center, Ulsan University Asan Medical Center, Seoul, Korea
    • ,
  • other Korea Acute Myocardial infarction Registry Investigators

Received 6 July 2009; accepted 14 December 2009.

Background

Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear.

Methods

A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared.

Results

The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95% CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95% CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95% CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex.

Conclusions

The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.

 

PII: S0002-8703(10)00088-8

doi:10.1016/j.ahj.2009.12.041

Refers to erratum:

  • Correction

    Seung-Woon Rha
    American Heart Journal July 2010 (Vol. 160, Issue 1, Page 208)

American Heart Journal
Volume 159, Issue 4 , Pages 684-690.e1, April 2010

Article Tools

* Image Usage & Resolution