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Observational Study
. 2025 Mar 28;25(1):231.
doi: 10.1186/s12872-025-04639-2.

Safety and efficacy of post-procedure anticoagulation in ST-elevation myocardial infarction complicated by cardiogenic shock undergoing primary percutaneous coronary intervention

Can Zhou #  1 , Minghui Zhang #  1 , Zixu Zhao #  1 , Enze Li #  1 , Yichen Zhao  1 , Hong Wang  1 , Wei Luo  1 , Keyang Zheng  1 , Yu Liu  1 , Chengqian Yin  1 , Xinyong Zhang  2 , Hai Gao  3 , Xiaotong Hou  1 , Dong Zhao  4 , Changsheng Ma  1
Affiliations
Observational Study

Safety and efficacy of post-procedure anticoagulation in ST-elevation myocardial infarction complicated by cardiogenic shock undergoing primary percutaneous coronary intervention

Can Zhou et al. BMC Cardiovasc Disord. .

Abstract

Introduction: Cardiogenic shock (CS) is a lethal complication of ST-elevation myocardial infarction (STEMI). The impact of post-procedure anticoagulants (PPAC) in STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) remains unknown.

Method: In the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome registry (2014-2019), STEMI patients with CS on admission undergoing PPCI were stratified into two groups based on the use of PPAC or not. The primary outcome was all-cause mortality during hospitalization. Other outcomes including major bleeding were also investigated.

Results: Of 36,873 patients with STEMI, 855 eligible patients with CS undergoing PPCI were included in our study, among which 614 patients were treated by PPAC and 241 were not. Adjusted by multi-variable Cox regression, PPAC was associated with a lower risk of in-hospital all-cause mortality (14.9% vs. 30.3%; adjusted HR: 0.60; 95% CI: 0.37 to 0.97; p = 0.037), while a non-significant difference in major bleeding (4.6% vs. 7.0%; adjusted HR: 1.05; 95% CI: 0.36 to 3.05; p = 0.925) was observed between PPAC and non-PPAC. Consistent results were observed in the sensitivity analyses adjusted by propensity score matching and inverse probability of treatment weighting.

Conclusion: Our study suggested the use of PPAC in STEMI-CS patients undergoing PPCI was associated with a lower risk of in-hospital all-cause mortality without increasing the risk of major bleeding.

Trial registration: ClinicalTrials.gov, NCT02306616. Registered 29 November 2014.

Keywords: Anticoagulation; Cardiogenic shock; Primary percutaneous coronary intervention; ST-elevation myocardial infarction.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board of Beijing Anzhen Hospital, and was conducted according to the guidelines outlined in the Declaration of Helsinki. Informed consent was secured from all individual participants involved in the study. Competing interests: The authors declare no competing interests. Clinical trial number: ClinicalTrials.gov, NCT02306616. Registered 29 November 2014.

Figures

Fig. 1
Fig. 1
Study flow chart The study population was derived from the nationwide, multicenter, prospective CCC-ACS (Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome) registry. STEMI = ST-segment Elevation Myocardial Infarction; CS = Cardiogenic shock; PPCI = primary percutaneous coronary intervention; PPAC = post-procedural anticoagulant
Fig. 2
Fig. 2
Cumulative Kaplan-Meier curves of all-cause mortality, major adverse cardiovascular event (MACE), net adverse cardiovascular event (NACE), and major bleeding HR = hazard ratio; CI = confidence interval; PPAC = post-procedural anticoagulant
Fig. 3
Fig. 3
Standardized mean differences for adjusted variables before and after adjustment of propensity score matching and inverse probability of treatment weighting in patients with STEMI-CS undergoing PPCI The X-axis represents the standardized mean differences value, and the Y-axis represents baseline adjusted variables. STEMI = ST-segment Elevation Myocardial Infarction; CS = Cardiogenic shock; PPCI = primary percutaneous coronary intervention; BMI = body mass index; LVEF = left ventricular ejection fraction; PCI = primary percutaneous coronary intervention; eGFR = estimated glomerular filtration rate; DAPT = dual antiplatelet therapy; LAD = left anterior descending artery
Fig. 4
Fig. 4
Subgroup analysis for all-cause mortality during hospitalization LVEF = left ventricular ejection fraction; eGFR = estimated glomerular filtration rate; DAPT = dual antiplatelet therapy; LMWH = low-molecular-weight heparin; PPAC = post-procedural anticoagulant
See this image and copyright information in PMC

References

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