In ST-segment elevation myocardial infarction (STEMI) patients, postprocedural anticoagulation (PPAC) is associated with reduced mortality without increasing the risk of major bleeding complications, according to new results from a registry study. Yan Yan, MD, and colleagues of Capital Medical University, Beijing, reported these findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCS-ACS) registry in a paper published online Monday and in the Feb. 14 issue of JACC: Cardiovascular Interventions. The CCC-ACS database is a prospective registry designed to improve ACS care in China. Eighty-two hospitals contribute data to this collaborative program of the American Heart Association and the Chinese Society of Cardiology. A total of 113,650 patients were enrolled during the study period, between November 2014 and December 2019. Of these, 34,826 had STEMI and underwent primary percutaneous coronary intervention (PPCI) and were included in the study. A total of 26,722 patients were treated with PPAC (PPAC group) and 8,544 were not (no-PPAC group). The primary efficacy endpoint was mortality, and the primary safety endpoint was major bleeding. At baseline, patients in the PPAC group were relatively younger (average age (60.7 vs. 61.8 years), more stable on admission, and had lower bleeding risk score but more likely to have comorbidities (including hypertension and hyperlipidemia) and multivessel disease. PPAC patients also had a longer median duration of hospital stay (8 vs. 7 days), and were more often treated within 12 hours of symptom onset than those without PPAC. After inverse probability of treatment weighting adjustment using propensity-score matching for baseline differences, PPAC patients were found to have a 38% reduced relative risk of in-hospital mortality (0.9% vs 1.8%; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.43-0.89; p<0.001) compared to patients in the no-PPAC group. This difference was largely driven by a lower incidence of cardiovascular death in the PPAC group (0.9% vs 1.8%; p<0.001; adjusted HR: 0.62; 95% CI: 0.43-0.90). The study found no difference in the rates of MI (0.2% vs 0.3%; p=0.18), stent thrombosis (0.2% vs 0.2%; p=0.22), and stroke (0.3% vs 0.3%; p=0.95) between the groups. Similarly, there was no significant difference in the risk of in-hospital major bleeding (2.5% vs 2.2%; HR: 1.05; 95% CI: 0.83-1.32; p=0.14). The main limitations of the study were its observational nature and missing data on indication, type of drug and dose of anticoagulation. However, the study reported that more than 90% of patients were prescribed low-molecular-weight heparin at least once during the acute phase following PPCI. The authors concluded that the study provides real-world data regarding PPAC being associated with a decreased risk of in-hospital mortality without increasing bleeding complications in STEMI patients undergoing PPCI. In an accompanying editorial, Felice Gragnano, MD, PhD, and Paolo Calabrò, MD, PhD, of the University of Campania “Luigi Vanvitelli and A.O.R.N. “Sant’Anna e San Sebastiano,” both in Caserta, Italy, stated that the study brings out a key unaddressed question of risks and benefits of either continuation or interruption of anticoagulation in the contemporary management of STEMI patients. The editorialists suggested that while there are several PPAC regimens have previously been evaluated, the optimal anticoagulation requires careful consideration of the tradeoff between thrombotic and bleeding risks associated with each antithrombotic regimen in patients presenting with STEMI. Further, they added, long-term treatment effects of these findings remain to be further investigated. Sources: Yan Y, Gong W, Ma C, et al. Postprocedure Anticoagulation in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022;15:251–263. Gragnano F, Calabrò P. Anticoagulation After Primary PCI: The Land of Promises and Uncertainty. JACC Cardiovasc Interv 2022;15:264–267. Image Credit: shidlovski – stock.adobe.com