Key result
Enoxaparin was associated with a reduced risk of in-hospital death and non-fatal reinfarction compared to unfractionated heparin in STEMI patients treated with primary PCI (OR 0.42; 95% CI 0.2-0.8).
Why the study?
Does enoxaparin reduce in-hospital death and reinfarction compared to unfractionated heparin in unselected STEMI patients treated with primary PCI?
Cohort (n=2,655)
Does enoxaparin reduce in-hospital death and reinfarction compared to unfractionated heparin in unselected STEMI patients treated with primary PCI?
In a real-world registry of STEMI patients undergoing primary PCI, enoxaparin was associated with a significant reduction in in-hospital death and reinfarction compared to unfractionated heparin, without increasing major bleeding.
May support enoxaparin preference in STEMI primary PCI; leaves open randomized confirmation before practice change.
AIMS: We sought to determine the efficacy of enoxaparin in unselected patients with STEMI treated with primary percutaneous coronary intervention in clinical practice. METHODS AND RESULTS: In a retrospective analysis of the prospective MITRA-plus registry we compared the outcomes of patients with primary PCI and either enoxaparin or unfractionated heparin. A total of 2,655 patients with STEMI < 12 hours were included in this analysis, 374 (14%) were treated with enoxaparin and 2,281 (86%) with unfractionated heparin. In the univariate analysis enoxaparin reduced mortality (1.6% versus 6.0%, < 0.001), fewer non-fatal reinfarctions (1.9% versus 3.8%, p = 0.05) and no significant difference in major bleeding (5.6% versus 7.2%, p = 0.2) was observed. In the multivariable propensity score analysis enoxaparin was associated with a reduction in the combined endpoint of death and non-fatal reinfarction (odds ratio 0.42; 95% CI 0.2-0.8). This advantage was observed both in subgroups without (odds ratio 0.33 95% CI 0.1-0.8) and with GP IIb/IIIa inhibitors (odds ratio 0.44, 95% CI 0.2-1.0). CONCLUSIONS: Our data suggest that in unselected patients with STEMI treated with primary PCI enoxaparin compared to unfractionated heparin reduces the combined endpoint of in-hospital death and reinfarction and does not increase severe bleeding complications.
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Zeymer et al. (2009) conducted a cohort in ST segment elevation myocardial infarction (STEMI) (n=2,655). Enoxaparin vs. Unfractionated heparin was evaluated on Combined endpoint of death and non-fatal reinfarction (OR 0.42, 95% CI 0.2-0.8). Enoxaparin was associated with a reduced risk of in-hospital death and non-fatal reinfarction compared to unfractionated heparin in STEMI patients treated with primary PCI (OR 0.42; 95% CI 0.2-0.8).
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