4.8 Article

Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial

期刊

LANCET
卷 378, 期 9792, 页码 693-703

出版社

ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(11)60876-3

关键词

-

资金

  1. Direction de la Recherche Clinique, Assistance Publique-Hopitaux de Paris
  2. Sanofi-Aventis
  3. Federation Francaise de Cardiologie
  4. Abbott Vascular
  5. AstraZeneca
  6. CLS Behring
  7. Daiichi Sankyo
  8. Eli Lilly
  9. Biotronik
  10. Iroko Cardio
  11. Bristol-Myers Squibb
  12. Merck
  13. Guerbet Medical
  14. Medtronic
  15. Boston Scientific
  16. Cordis
  17. Stago
  18. Fondation de France
  19. INSERM
  20. Societe Francaise de Cardiologie
  21. Medicines Company
  22. Pfizer
  23. Schering-Plough
  24. ITC Edison
  25. Cardiovascular Research Foundation
  26. Cleveland Clinic Research Foundation
  27. Duke Institute
  28. Europa
  29. Lead-up
  30. Institut de Cardiologie de Montreal
  31. Menarini
  32. Nanospheres
  33. Novartis
  34. Portola
  35. TIMI study group
  36. Brahms
  37. Abbott
  38. Amgen
  39. Servier

向作者/读者索取更多资源

Background Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction has traditionally been supported by unfractionated heparin, which has never been directly compared with a new anticoagulant using consistent anticoagulation and similar antiplatelet strategies in both groups. We compared traditional heparin treatment with intravenous enoxaparin in primary PCI. Methods In a randomised open-label trial, patients presenting with ST-elevation myocardial infarction were randomly assigned (1:1) to receive an intravenous bolus of 0.5 mg/kg of enoxaparin or unfractionated heparin before primary PCI. Wherever possible, medical teams travelling in mobile intensive care units (ambulances) selected, randomly assigned (using an interactive voice response system at the central randomisation centre), and treated patients. Patients who had received any anticoagulant before randomisation were excluded. Patients and caregivers were not masked to treatment allocation. The primary endpoint was 30-day incidence of death, complication of myocardial infarction, procedure failure, or major bleeding. The main secondary endpoint was the composite of death, recurrent acute coronary syndrome, or urgent revascularisation. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00718471. Findings 910 patients were assigned to treatment with enoxaparin (n=450) or unfractionated heparin (n=460). The primary endpoint occurred in 126 (28%) patients after anticoagulation with enoxaparin versus 155 (34%) patients on unfractionated heparin (relative risk [RR] 0 83, 95% CI 0.68-1.01, p=0.06). The incidence of death (enoxaparin, 17 [4%] vs heparin, 29 [6%] patients; p=0.08), complication of myocardial infarction (20 [4%] vs 29 [6%]; p=0.21), procedure failure (100 [26%] vs 109 [28%]; p=0.61), and major bleeding (20 [5%] vs 22 [5%]; p=0.79) did not differ between groups. Enoxaparin resulted in a significantly reduced rate of the main secondary endpoint (30 [7%] vs 52 [11%] patients; RR 0.59, 95% CI 0.38-0.91, p=0.015). Death, complication of myocardial infarction, or major bleeding (46 [10%] vs 69 [15%] patients; p=0.03), death or complication of myocardial infarction (35 [8%] vs 57 [12%]; p=0.02), and death, recurrent myocardial infarction, or urgent revascularisation (23 [5%] vs 39 [8%]; p=0.04) were all reduced with enoxaparin. Interpretation Intravenous enoxaparin compared with unfractionated heparin significantly reduced clinical ischaemic outcomes without differences in bleeding and procedural success. Therefore, enoxaparin provided an improvement in net clinical benefit in patients undergoing primary PCI.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.8
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据