October 15, 2019Catheterization and Cardiovascular Interventions
Upstream anticoagulation for patients with ST‐elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the TOTAL trial
Key result
Among 10,064 STEMI patients undergoing primary PCI, preprocedural anticoagulation (63%) improved initial flow but showed no significant difference in death, recurrent MI, or heart failure at 1 year.
Why the study?
For patients with STEMI undergoing primary PCI, the optimal timing of anticoagulant administration remains uncertain.
Does preprocedural parenteral anticoagulation improve clinical and angiographic outcomes in patients with STEMI undergoing primary PCI?
Population
10,064 STEMI patients undergoing primary PCI enrolled in the TOTAL trial
Comparison
Preprocedural parenteral anticoagulation vs no preprocedural anticoagulation
Design
Propensity score-adjusted observational post-hoc analysis of a randomized trial
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Preprocedural anticoagulation was associated with better pre-PCI flow; leaves open whether routine upstream use improves clinical outcomes in STEMI.
Study Design
Type
Observational (n=10,064)
Structured PICO
Does preprocedural parenteral anticoagulation improve clinical and angiographic outcomes in patients with STEMI undergoing primary PCI?
P
Population
10,064 patients with STEMI undergoing primary PCI enrolled in the TOTAL trial, followed for 1 year.
E
Exposure
Preprocedural parenteral anticoagulation (most commonly intravenous unfractionated heparin, n=5,188, 81%)
C
Comparator
No preprocedural parenteral anticoagulation
O
Outcome
One-year clinical outcomes (death, stroke, recurrent MI, cardiogenic shock, or congestive heart failure) and angiographic endpoints (TIMI flow, thrombus grade)hard clinical
Upstream anticoagulation before primary PCI in STEMI improves initial vessel patency and reduces thrombus burden but does not translate to improved 1-year hard clinical outcomes.
Cite This Study
Cantor et al. (2019) conducted an observational in ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) (n=10,064). Preprocedural anticoagulation vs. No preprocedural anticoagulation was evaluated on Death, stroke, recurrent MI, cardiogenic shock, or congestive heart failure at 1 year. Among 10,064 STEMI patients undergoing primary PCI, preprocedural anticoagulation (63%) improved initial flow but showed no significant difference in death, recurrent MI, or heart failure at 1 year.