PMID- 22511592
OWN - NLM
STAT- MEDLINE
DCOM- 20130711
LR  - 20130102
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 81
IP  - 1
DP  - 2013 Jan 1
TI  - Relationship between the intensity of heparin anticoagulation and clinical 
      outcomes in patients receiving glycoprotein IIb/IIIa inhibitors during primary 
      percutaneous coronary intervention in acute myocardial infarction.
PG  - E9-14
LID - 10.1002/ccd.24279 [doi]
AB  - OBJECTIVES: We sought to determine the impact of the activated clotting time 
      (ACT) in patients with ST elevation myocardial infarction (STEMI) undergoing 
      primary percutaneous coronary intervention (PCI) with unfractionated heparin 
      (UFH) and a glycoprotein IIb/IIIa inhibitor (GPI). BACKGROUND: UFH+GPI is 
      commonly used during primary PCI for STEMI. UFH anticoagulation is titrated with 
      ACT. METHODS: Patients randomized to UFH+GPI in HORIZONS-AMI who underwent 
      primary PCI are included (N = 1,624). Initial UFH bolus was 60 IU kg(-1) (target 
      ACT: 200-250 sec). Patients were divided into three tertiles of peak ACT (cutoffs 
      240 and 298 sec). The 30-day rates of major and minor bleeding, major adverse 
      cardiovascular events (MACE), and net adverse clinical events (NACE; MACE or 
      major bleeding) were determined. RESULTS: Mortality at 30 days occurred in 2.2, 
      3.3, and 3.5% of patients in the low to high ACT tertiles, respectively (P(trend) 
      = 0.22). Nor was the peak ACT significantly related to major bleeding, MACE or 
      NACE. However, minor bleeding was increased in the highest ACT tertile (14.7% vs. 
      14.2% vs. 19.4%, P(trend) = 0.04). By multivariable analysis peak ACT was not 
      significantly related to major bleeding, mortality, MACE, and NACE but was a 
      significant independent predictor of minor bleeding (odds ratio = 1.027 [1.013, 
      1.042], P < 0.001, for each 10 sec increase in ACT). CONCLUSIONS: In patients 
      undergoing primary PCI for STEMI treated with UFH+GPI, the peak procedural ACT 
      achieved does not have a substantial effect on major bleeding, mortality, or 
      MACE, although lower peak ACT is associated with less minor bleeding.
CI  - Copyright (c) 2012 Wiley Periodicals, Inc.
FAU - Rozenman, Yoseph
AU  - Rozenman Y
AD  - The Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv 
      University, Tel-Aviv, Israel. yosephr@post.tau.ac.il.
FAU - Mehran, Roxana
AU  - Mehran R
FAU - Witzenbichler, Bernhard
AU  - Witzenbichler B
FAU - Dangas, George
AU  - Dangas G
FAU - Desaga, Martin
AU  - Desaga M
FAU - Kochman, Janusz
AU  - Kochman J
FAU - Nilsen, Dennis W
AU  - Nilsen DW
FAU - Finkelstein, Ariel
AU  - Finkelstein A
FAU - Mosseri, Morris
AU  - Mosseri M
FAU - Stone, Gregg W
AU  - Stone GW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20120417
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*methods/mortality
MH  - Combined Modality Therapy
MH  - Electrocardiography/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Israel
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Infarction/diagnosis/*therapy
MH  - Percutaneous Coronary Intervention/methods/mortality
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*administration & dosage
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Single-Blind Method
MH  - Survival Rate
MH  - Thrombolytic Therapy/adverse effects/methods
MH  - Treatment Outcome
EDAT- 2012/04/19 06:00
MHDA- 2013/07/13 06:00
CRDT- 2012/04/19 06:00
PHST- 2011/05/23 00:00 [received]
PHST- 2011/07/16 00:00 [revised]
PHST- 2011/11/25 00:00 [accepted]
PHST- 2012/04/19 06:00 [entrez]
PHST- 2012/04/19 06:00 [pubmed]
PHST- 2013/07/13 06:00 [medline]
AID - 10.1002/ccd.24279 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2013 Jan 1;81(1):E9-14. doi: 10.1002/ccd.24279. Epub 
      2012 Apr 17.