Chowdhury Anika, Vasoya Dhruvkumar Arvindbhai, Ima Mahfuja Jahan, Koppula Srija Reddy, Das Ashesh, Dhivakaran Kiran Kumar, Khawar Muhammad Muneeb, Mishra Aadya, Safiullah Muhammad, Siddique Saman, Lee Deng Siang, Hamza Muhammad, Tandel Hemeesh, Chatterjee Aniket
Shaheed Suhrawardy Medical College and Hospital, Dhaka, 1207, Bangladesh.
First affiliated hospital of Soochow University, Suzhou, China.
J Thromb Thrombolysis. 2025 Jun 22. doi: 10.1007/s11239-025-03130-1.
Percutaneous Coronary Intervention (PCI) is a widely used minimally invasive procedure that restores blood flow to the coronary artery, improving survival in STEMI patients. Despite its widespread application in clinical settings, the necessity and efficacy of postprocedural anticoagulation (PPAC) remain contentious. Our study aims to assess the outcomes of PPAC in STEMI patients who have undergone PCI. A comprehensive search of Embase, PubMed, and Clinicaltrials was conducted to identify randomized controlled trials (RCTs) comparing the clinical outcomes between PPAC and control (placebo or no PPAC) for STEMI after primary PCI. Statistical analyses were performed using RevMan version 5.4.1, employing a random-effects model to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Risk of Bias Assessment of the articles was assessed using RoB 2.0 software by the Cochrane Collaboration. A total of 5 RCTs comprising 13,586 patients were included, of which 6,829 patients (50.26%) received PPAC. Compared to the non-PPAC group, PPAC did not significantly reduce all-cause mortality (OR 1.08; 95% CI 0.84-1.39; P = 0.54, I = 0%), cardiovascular mortality (OR 1.08; 95% CI 0.83-1.39; P = 0.57, I = 0%), and MACE (major adverse cardiovascular events) (OR 1.13; 95% CI 0.92-1.37; P = 0.25, I = 22%). Additionally, the odds of stent thrombosis (OR 1.07; 95% CI 0.77-1.47; P = 0.69, I = 0%) and stroke (OR 1.50; 95% CI 0.49-4.57; P = 0.48, I = 58%) did not differ significantly between the groups. However, PPAC was associated with higher odds of bleeding (OR 1.78; 95% CI 1.07-2.97; P = 0.03, I = 94%). This meta-analysis reveals no significant differences in the odds of all-cause mortality, cardiovascular mortality, stent thrombosis, and stroke between PPAC and control following PCI for the management of STEMI. However, PPAC was associated with higher odds of bleeding. Further randomized controlled trials are warranted to corroborate these findings.
经皮冠状动脉介入治疗（PCI）是一种广泛应用的微创手术，可恢复冠状动脉血流，提高ST段抬高型心肌梗死（STEMI）患者的生存率。尽管其在临床环境中广泛应用，但术后抗凝（PPAC）的必要性和疗效仍存在争议。我们的研究旨在评估接受PCI的STEMI患者PPAC的效果。对Embase、PubMed和Clinicaltrials进行了全面检索，以确定比较PPAC与对照组（安慰剂或无PPAC）在直接PCI后STEMI患者临床结局的随机对照试验（RCT）。使用RevMan 5.4.1版进行统计分析，采用随机效应模型计算比值比（OR）及其95%置信区间（CI）。由Cochrane协作网使用RoB 2.0软件对文章进行偏倚风险评估。共纳入5项RCT，涉及13586例患者，其中6829例患者（50.26%）接受了PPAC。与非PPAC组相比，PPAC并未显著降低全因死亡率（OR 1.08；95%CI 0.84 - 1.39；P = 0.54，I = 0%）、心血管死亡率（OR 1.08；95%CI 0.83 - 1.39；P = 0.57，I = 0%）和主要不良心血管事件（MACE）（OR 1.13；95%CI 0.92 - 1.37；P = 0.25，I = 22%）。此外，两组之间支架血栓形成的几率（OR 1.07；95%CI 0.77 - 1.47；P = 0.69，I = 0%）和中风的几率（OR 1.50；95%CI 0.49 - 4.57；P = 0.48，I = 58%）无显著差异。然而，PPAC与出血几率较高相关（OR 1.78；95%CI 1.07 - 2.97；P = 0.03，I = 94%）。这项荟萃分析表明，在PCI治疗STEMI后，PPAC与对照组在全因死亡率、心血管死亡率、支架血栓形成和中风几率方面无显著差异。然而，PPAC与出血几率较高相关。有必要进行进一步的随机对照试验来证实这些发现。
