PMID- 20362730 OWN - NLM STAT- MEDLINE DCOM- 20100513 LR - 20101118 IS - 1097-6744 (Electronic) IS - 0002-8703 (Linking) VI - 159 IP - 4 DP - 2010 Apr TI - Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents. PG - 684-690.e1 LID - 10.1016/j.ahj.2009.12.041 [doi] AB - 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. CI - Copyright 2010 Mosby, Inc. All rights reserved. FAU - Li, Yong-Jian AU - Li YJ AD - Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea. FAU - Rha, Seung-Woon AU - Rha SW FAU - Chen, Kang-Yin AU - Chen KY FAU - Poddar, Kanhaiya L AU - Poddar KL FAU - Jin, Zhe AU - Jin Z FAU - Minami, Yoshiyasu AU - Minami Y FAU - Wang, Lin AU - Wang L FAU - Dang, Qun AU - Dang Q FAU - Li, Guang-Ping AU - Li GP FAU - Ramasamy, Sureshkumar AU - Ramasamy S FAU - Park, Ji-Young AU - Park JY FAU - Choi, Cheol Ung AU - Choi CU FAU - Kim, Jin-Won AU - Kim JW FAU - Kim, Eung Ju AU - Kim EJ FAU - Park, Chang Gyu AU - Park CG FAU - Seo, Hong Seog AU - Seo HS FAU - Oh, Dong Joo AU - Oh DJ FAU - Jeong, Myung Ho AU - Jeong MH FAU - Ahn, Young Keun AU - Ahn YK FAU - Hong, Taek Jong AU - Hong TJ FAU - Park, Jong-Seon AU - Park JS FAU - Kim, Young Jo AU - Kim YJ FAU - Hur, Seung Ho AU - Hur SH FAU - Seong, In Whan AU - Seong IW FAU - Chae, Jei Keon AU - Chae JK FAU - Cho, Myeong Chan AU - Cho MC FAU - Bae, Jang Ho AU - Bae JH FAU - Choi, Dong Hoon AU - Choi DH FAU - Jang, Yang Soo AU - Jang YS FAU - Chae, In Ho AU - Chae IH FAU - Kim, Hyo Soo AU - Kim HS FAU - Kim, Chong Jin AU - Kim CJ FAU - Yoon, Jung Han AU - Yoon JH FAU - Ahn, Tae Hoon AU - Ahn TH FAU - Tahk, Seung-Jea AU - Tahk SJ FAU - Chung, Wook Sung AU - Chung WS FAU - Seung, Ki Bae AU - Seung KB FAU - Park, Seung Jung AU - Park SJ CN - other Korea Acute Myocardial infarction Registry Investigators LA - eng PT - Clinical Trial PT - Journal Article PT - Multicenter Study PL - United States TA - Am Heart J JT - American heart journal JID - 0370465 RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) SB - IM EIN - Am Heart J. 2010 Jul;160(1):208. Choi, Chol Ung [corrected to Choi, Cheol Ung] CIN - Am Heart J. 2010 Aug;160(2):e13; author reply e15-6. PMID: 20691818 CIN - Am Heart J. 2010 Sep;160(3):e25; author reply e27. PMID: 20826240 MH - Aged MH - *Angioplasty, Balloon, Coronary MH - Anticoagulants/*administration & dosage MH - Drug Therapy, Combination MH - Drug-Eluting Stents MH - Electrocardiography MH - Enoxaparin/*administration & dosage MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/drug therapy/*therapy MH - Treatment Outcome FIR - Jeong, Myung Ho IR - Jeong MH FIR - Kim, Young Jo IR - Kim YJ FIR - Kim, Chong Jin IR - Kim CJ FIR - Cho, Myeong Chan IR - Cho MC FIR - Ahn, Young Keun IR - Ahn YK FIR - Kim, Jong Hyun IR - Kim JH FIR - Chae, Shung Chull IR - Chae SC FIR - Hur, Seung Ho IR - Hur SH FIR - Seong, In Whan IR - Seong IW FIR - Hong, Taek Jong IR - Hong TJ FIR - Choi, Dong Hoon IR - Choi DH FIR - Chae, Jei Keon IR - Chae JK FIR - Rhew, Jae Young IR - Rhew JY FIR - Kim, Doo Il IR - Kim DI FIR - Chae, In Ho IR - Chae IH FIR - Yoon, Jung Han IR - Yoon JH FIR - Koo, Bon Kwon IR - Koo BK FIR - Kim, Byung Ok IR - Kim BO FIR - Lee, Myoung Yong IR - Lee MY FIR - Kim, Kee Sik IR - Kim KS FIR - Hwang, Jin Yong IR - Hwang JY FIR - Oh, Seok Kyu IR - Oh SK FIR - Lee, Nae Hee IR - Lee NH FIR - Jeong, Kyoung Tae IR - Jeong KT FIR - Tahk, Seung Jea IR - Tahk SJ FIR - Bae, Jang Ho IR - Bae JH FIR - Rha, Seung Woon IR - Rha SW FIR - Park, Keum Soo IR - Park KS FIR - Han, Kyoo Rok IR - Han KR FIR - Ahn, Tae Hoon IR - Ahn TH FIR - Kim, Moo Hyun IR - Kim MH FIR - Yang, Ju Young IR - Yang JY FIR - Rhim, Chong Yun IR - Rhim CY FIR - Gwon, Hyeon Cheol IR - Gwon HC FIR - Park, Seong Wook IR - Park SW FIR - Koh, Young Youp IR - Koh YY FIR - Joo, Seung Jae IR - Joo SJ FIR - Kim, Soo Joong IR - Kim SJ FIR - Jin, Dong Kyu IR - Jin DK FIR - Cho, Jin Man IR - Cho JM FIR - Cho, Jeong Gwan IR - Cho JG FIR - Chung, Wook Sung IR - Chung WS FIR - Jang, Yang Soo IR - Jang YS FIR - Seung, Ki Bae IR - Seung KB FIR - Park, Seung Jung IR - Park SJ EDAT- 2010/04/07 06:00 MHDA- 2010/05/14 06:00 CRDT- 2010/04/06 06:00 PHST- 2009/07/06 00:00 [received] PHST- 2009/12/14 00:00 [accepted] PHST- 2010/04/06 06:00 [entrez] PHST- 2010/04/07 06:00 [pubmed] PHST- 2010/05/14 06:00 [medline] AID - S0002-8703(10)00088-8 [pii] AID - 10.1016/j.ahj.2009.12.041 [doi] PST - ppublish SO - Am Heart J. 2010 Apr;159(4):684-690.e1. doi: 10.1016/j.ahj.2009.12.041.