Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, 149(16), 1258–1267. https://doi.org/10.1161/CIRCULATIONAHA.123.067079 Dr. Yan Yan et al.
Points
- The RIGHT trial investigated the efficacy of postprocedural anticoagulation (PPA) in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
- 2989 patients across 53 centers were randomized to receive low-dose PPA or a matching placebo for at least 48 hours.
- The trial aimed to demonstrate the superiority of PPA in reducing the composite primary efficacy endpoint of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis, or urgent revascularization within 30 days.
- Results showed that routine PPA after primary PCI was safe but did not reduce 30-day ischemic events, as the incidence of the primary efficacy endpoint and significant bleeding did not differ between the PPA and placebo groups.
- The findings contribute to the ongoing discourse on postprocedural anticoagulation practices in STEMI patients undergoing primary PCI and highlight the need for further research.
Summary
The RIGHT trial, a multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted in China, aimed to investigate the efficacy of postprocedural anticoagulation (PPA) in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). 2989 patients were randomized across 53 centers to receive low-dose PPA or a matching placebo for at least 48 hours. The primary efficacy objective was to demonstrate the superiority of PPA in reducing the composite primary efficacy endpoint of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), or urgent revascularization (any vessel) within 30 days. The trial also aimed to evaluate the effect of specific anticoagulation regimens (enoxaparin, unfractionated heparin, or bivalirudin) on the primary efficacy endpoint, with the primary safety endpoint being Bleeding Academic Research Consortium 3 to 5 bleeding at 30 days.
The results revealed that the incidence of the primary efficacy endpoint did not significantly differ between the PPA and placebo groups, with 37 patients (2.5%) experiencing the event in both groups. Additionally, the occurrence of Bleeding Academic Research Consortium 3 or 5 bleeding did not show a significant difference between the PPA and placebo groups. Consequently, the trial concluded that routine PPA after primary PCI was safe but did not reduce 30-day ischemic events.
In summary, the RIGHT trial’s findings suggest that while routine PPA after primary PCI was deemed safe, it did not significantly reduce 30-day ischemic events. These results provide valuable insights into the efficacy of PPA in the context of STEMI patients undergoing primary PCI, contributing to the ongoing discourse on postprocedural anticoagulation practices.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067079
References
Yan, Y., Guo, J., Wang, X., Wang, G., Fan, Z., Yin, D., Wang, Z., Zhang, F., Tian, C., Gong, W., Liu, J., Lu, J., Li, Y., Ma, C., Vicaut, E., MontalescAot, G., Nie, S., & on behalf of the RIGHT Investigators. (2024). Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial. Circulation, 149(16), 1258–1267. https://doi.org/10.1161/CIRCULATIONAHA.123.067079
