J Korean Med Sci.  2010 Nov;25(11):1601-1608. 10.3346/jkms.2010.25.11.1601.

Clinical Benefit of Low Molecular Weight Heparin for ST-segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention with Glycoprotein IIb/IIIa Inhibitor

• Cho JS
• Her SH
• Baek JY
• Park MW
• Kim HD
• Jeong MH
• Ahn YK
• Chae SC
• Hur SH
• Hong TJ
• Kim YJ
• Seong IW
• Chae JK
• Rhew JY
• Chae IH
• Cho MC
• Bae JH
• Rha SW
• Kim CJ
• Choi D
• Jang YS
• Yoon J
• Chung WS
• Cho JG
• Seung KB
• Park SJ

• KMID: 1779230
• DOI: http://doi.org/10.3346/jkms.2010.25.11.1601

Abstract

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.

Keyword

Myocardial Infarction; Heparin; Blood Platelets; Prognosis

MeSH Terms

Acute Disease
Aged
Drug Therapy, Combination
Female
Hemorrhage
Heparin/*therapeutic use
Heparin, Low-Molecular-Weight/*therapeutic use
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction/epidemiology/mortality/*therapy
Myocardial Revascularization
Odds Ratio
Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism
Prognosis
Registries

Figure

• 

  Fig. 1 Flow chart of patients who entered the study. KAMIR, Korean Acute Myocardial Infarction Registry; STEMI, ST-elevation myocardial infarction; LMWH, low molecular weight heparin; PCI, percutaneous coronary intervention; UFH, unfractionated heparin.

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  Fig. 2 Concomitant medications during hospitalization. GPI, glycoprotein IIb/IIIa inhibitor; ACE, angiotensin converting enzyme; ARB, aldosterone receptor inhibitor; CCB, calcium channel blocker.

• 

  Fig. 3 Hazard ratio plots of independent predictors with the multivariable analyses for death or myocardial infarction in 30 days in UFH and LMWH groups with glycoprotein IIb/IIIa inhibitor (A) and without glycoprotein IIb/IIIa inhibitor (B) in STEMI patients who underwent primary PCI. *Defined as coronary heart disease in first-degree male relative <55 yr old or coronary heart disease in first-degree female relative <65 yr old. LMWH, low molecular weight heparin; UFH, unfractionated heparin; STEMI, ST-elevation myocardial infarction; PCI, percutaneous coronary intervention.

• 

  Fig. 4 Kaplan-Meier analysis of primary endpoint of UFH and LMWH groups with glycoprotein IIb/IIIa inhibitor (A) and without glycoprotein IIb/IIIa inhibitor (B) in STEMI patients who underwent primary PCI. LMWH, low molecular weight heparin; UFH, unfractionated heparin; STEMI, ST-elevation myocardial infarction; PCI, percutaneous coronary intervention.

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