Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial

作者：Yan Yan, Jincheng Guo, Xiao Wang, Guozhong Wang, Zeyuan Fan, Delu Yin, Zhifang Wang, Fuchun Zhang, Changming Tian, Wei Gong, J Liu, Jiapeng Lu, Yongjun Li, Changsheng Ma, Éric Vicaut, Gilles Montalescot, Shaoping Nie, on behalf of the RIGHT Investigators · 发表于：Circulation · 年份：2024 · DOI：10.1161/circulationaha.123.067079 · 被引用次数：24 · 研究领域：Acute Myocardial Infarction Research、Atrial Fibrillation Management and Outcomes、Mechanical Circulatory Support Devices

BACKGROUND: Postprocedural anticoagulation (PPA) is frequently administered after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction, although no conclusive data support this practice. METHODS: The RIGHT trial (Comparison of Anticoagulation Prolongation vs no Anticoagulation in STEMI Patients After Primary PCI) was an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted at 53 centers in China. Patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomly assigned by center to receive low-dose PPA or matching placebo for at least 48 hours. Before trial initiation, each center selected 1 of 3 PPA regimens (40 mg of enoxaparin once daily subcutaneously; 10 U·kg·h of unfractionated heparin intravenously, adjusted to maintain activated clotting time between 150 and 220 seconds; or 0.2 mg·kg·h of bivalirudin intravenously). The primary efficacy objective was to demonstrate superiority of PPA to reduce the primary efficacy end point of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), or urgent revascularization (any vessel) within 30 days. The key secondary objective was to evaluate the effect of each specific anticoagulation regimen (enoxaparin, unfractionated heparin, or bivalirudin) on the primary efficacy end point. The primary safety end point was Bleeding Academic Research Co...