022: Compared efficacy and safety of unfractionned heparins versus low-molecular-weight heparins in STEMI patients

BackgroundLow-molecular-weight heparins have recently been introduced in the management of ST elevation myocardial infarction (STEMI) patients but evidence remains poor among specific populations particularly elderly and patients with renal dysfunction.Objectiveto compare the outcome (mortality and hemorrhage) between patients treated with unfractionned heparin (UFH) versus low-molecular-weight heparins (LMWHs) in the whole population and among elderly and renal dysfunction patients.MethodsPatients admitted for STEMI between January 1995 and November 2011 were retrospectively enrolled in the MIRAMI (MonastIR Acute Myocardial Infarction) registry. We compared the outcome (mortality and hemorrhage) between patients who received UFH versus LMWHs in the global MIRAMI population, then among elderly (aged over 75 years) and renal dysfunction patients (defined by a creatinin level >130μmol/l).RésultatsUFH was more often used when thrombolysis was adopted as reperfusion therapy (80.6% vs 68.6% when primary angioplasty is adopted, p<0.001), when patients present with heart failure (p<0.001), among elderly (p<0.001) and in patients with renal dysfunction (p=0.002). High rates of prescription of UFH may be attributed to the enrollment of patients since 1995, before LMWHs introduction in clinical practice. Mortality was higher among patient treated with UFH. This difference was statistically significant in the global population (11.9% vs 3.1%, p