Association between post procedural parenteral anticoagulation therapy and clinical outcomes in ST-elevation myocardial infarction patients with high thrombotic risk.

Background: Current guidelines advise against routine use of parenteral anticoagulation therapy (PACT) for ST-segment elevated myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). However, the effectiveness of PACT in such patients with high thrombotic risk remains uncertain. To determine the impact of PACT on STEMI patients with high thrombotic risk. Methods: We enrolled STEMI patients with high thrombotic risk from four Chinese hospitals between 1 January 2010, and 31 December 2022. STEMI patients with high thrombotic risk were categorized them into PACT and non-PACT groups. We used multivariate, propensity score, and subgroup analyses to examine the relationship between PACT and clinical outcomes. The primary outcomes were in-hospital all-cause death and in-hospital major bleeding. Results: Out of 2,001 PCI patients, 473 received PACT. PACT was not associated with a lower all-cause death (adjusted OR, 0.70; 95% CI, 0.33-1.48; P = 0.349) and was not associated with an increased risk of major bleeding (adjusted OR, 0.84; 95% CI, 0.32-2.18; P = 0.720). After a median follow-up of 1.72 years, PACT did not significantly affect all-cause death and major adverse clinical events compared to non-PACT, as confirmed by propensity score and subgroup analyses. Conclusion: PACT was not statistically associated with a reduced risk of in-hospital all-cause death and an increased risk of major bleeding in STEMI patients with high thrombotic risk.