Low molecular weight heparin for AMI with frailty: short-Term outcomes after early PCI
F Z Q Fang, Z Z Zhang, G R X Guo, X Z K Xue, S X Shao, Z H Zhang, L X Liu, L T Liu, C K Y ChenAbstract
Background
Low molecular weight heparin (LMWH) is widely used in patients with acute myocardial infarction (AMI) undergoing early percutaneous coronary intervention (PCI). However, its impact on short-term adverse outcomes in frail patients with AMI undergoing early PCI remains unclear.
Purpose
This study aimed to evaluate the effect of LMWH on short-term adverse outcomes in frail patients with AMI undergoing early PCI.
Methods
Data were sourced from the Coronary Artery Disease specialized database, comprising a retrospective multicenter cohort of patients discharged from 82 hospitals between 2010 and 2024. Patients were stratified into the LMWH group and control group (no LMWH, fondaparinux, or bivalirudin). Baseline covariates, including the use of unfractionated heparin, were balanced between the two groups through propensity score matching (PSM). Multivariable cox regression analyzed the association between LMWH use and outcomes in this cohort. Kaplan-Meier analysis with log-rank tests compared endpoint risks between groups.The primary endpoint focused on major adverse cardiovascular and cerebrovascular events (MACCE, composite of cardiac death, myocardial infarction, ischemic stroke) and net adverse clinical event (NACE, composite of all-cause death, myocardial infarction, ischemic stroke, BARC type 3 bleeding) within 30 days.The secondary endpoints were the components of MACCE and NACE.
Results
After 1:6 propensity score matching, 8,248 frail patients with AMI undergoing early PCI were enrolled, including 7,004 who received LMWH and 1,244 who did not. Post-matching balance was satisfactory, with absolute standardized mean differences below 0.1 for all covariates(Table 1). Cox regression analysis revealed that LMWH reduced MACCE (aHR = 0.51, 95% CI = 0.39-0.66, P < 0.001) and NACE (aHR = 0.48, 95% CI = 0.38-0.62, P < 0.001) at 30 days. These findings remained consistent in the secondary outcomes (cardiac death: aHR = 0.43, 95% CI = 0.32-0.58, P < 0.001; all-cause death: aHR = 0.40, 95% CI = 0.30-0.53, P < 0.001)(Figure 1). Kaplan-Meier analysis demonstrated a significantly lower risk of MACCE and NACE in the LMWH group (log-rank P<0.001, Figure 2A, B).
Conclusions
In frail patients with AMI undergoing early PCI, the use of low molecular weight heparin demonstrates benefits in short-term cardiovascular, cerebrovascular and net adverse clinical events.Table 1.Baseline Characteristics