Postprocedural Anticoagulation Following Primary Percutaneous Coronary Intervention for ST‐Segment Elevation Myocardial Infarction: A Meta‐Analysis of 47,310 Patients

BACKGROUND: The use of procedural anticoagulation during primary percutaneous coronary intervention (PCI) is well established and has been shown to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Despite its widespread application in clinical settings, the necessity and effectiveness of postprocedural anticoagulation (PPAC) remain contentious. AIMS: To assess the effectiveness and safety of PPAC after PCI for the management of STEMI. METHODS: We queried PubMed, Cochrane and Embase to identify studies comparing the clinical outcomes between control (placebo or no infusion) and PPAC after PCI for treating STEMI. The review was conducted using Cochrane and PRISMA guidelines, and R 4.4.2 was used to perform all statistical analyses. A random-effects model was employed to assess risk ratios (RRs) and their 95% confidence intervals (CIs). RESULTS: A total of five studies comprising 47,310 patients were included, of which 32,548 (68.7%) received PPAC. Mean age ranged from 60.7 (12.4) to 70.0 (11.9) and 37,504 (79.2%) of them were female. Compared with control, PPAC did not significantly reduce all-cause mortality (RR 0.87; 95% CI 0.59-1.30; p = 0.61), cardiac death (RR 0.88; 95% CI 0.59-1.31; p = 0.52), and MACE (RR 1.03; 95% CI 0.75-1.41; p = 0.85). Moreover, the risk of stent thrombosis (RR 1.16; 95% CI 0.87-1.53; p = 0.31), MI (RR 1.02; 95% CI 0.78-1.32; p = 0.90), stroke (RR 0.97; 95% CI 0.36-2.57; p = 0.94) and TIMI major bleeding (RR 1.03; 95% CI 0.45-2.39; p = 0.94) were comparable across groups. However, patients assigned to PPAC were associated with higher risk of TIMI major/minor bleeding (RR 1.55; 95% CI 1.38-1.73; p < 0.01) and NACE (RR 1.36; 95% CI 1.14-1.61; p < 0.01). CONCLUSIONS: This meta-analysis reveals no significant differences in the risk of all-cause mortality, cardiac death, MACE, stent thrombosis, stroke and TIMI major bleeding between placebo and PPA after PCI in STEMI patients. However, PPAC is associated with higher risk of TIMI major/minor bleeding. Further randomized controlled trials are warranted to validate these findings.