Abstract 12831: Impact of Fondaparinux vs Low Molecular Weight Heparin on In-hospital Bleeding and One-year Death in Non-ST-segment Elevation Myocardial Infarction: Should we Apply the ESC Guidelines? Real-world Data from FAST-MI 2010
Background: ESC guidelines recommend fondaparinux as the best anticoagulant in patients with non-ST-elevation Acute Myocardial Infarction (NSTEMI), whereas ACC/AHA guidelines do not favor fondaparinux over low molecular weight heparin (LMWH) or unfractionated heparin (UFH).
Aim and methods: We assessed one-year death in NSTEMI patients included in the French FAST-MI 2010 registry according to the use of fondaparinux (alone or with unfractionated heparin) compared with LMWH at the acute stage. Associations between treatment and one-year death were assessed by Cox multivariate regression analysis, and propensity score matching.
Results: 1267 NSTEMI patients included in FAST-MI at the end of 2010 received either fondaparinux (N= 240, 19%) or LMWH (1067 patients, 81%). The 2 groups were similar in many respects, including age (66+/-13 vs 67+/-14 years) and GRACE score (134 +/-38 vs 133 +/-39); use of fondaparinux, however, varied across regions (from 1% to 37%). The use of coronary angiography (93%) and PCI (69%) was similar in both groups. In-hospital reinfarction was 1.7% vs 1.1% (P=0.44) and TIMI major bleeding was 1.7% vs 2.1% (P=0.64). Adjusted risk of one-year death with fondaparinux was 1.46 (95%CI: 0.75-2.84)); HR was 2.93 (1.34-6.37) in patients treated with fondaparinux alone and 1.43 (0.74-2.77) in those treated with fondaparinux and heparin. After propensity score matching, including both patient characteristics, concomitant therapy and geographical region, two well-balanced cohorts of 207 patients were constituted. Recurrent MI was 1.9% vs 0 (P=0.12) and TIMI major bleed 1.9% in both groups. One-year Kaplan-Meier survival was 91% (fondaparinux) vs 92% (LMWH) (P=0.71) ((Figure 1).
Conclusion: in this real-world cohort of NSTEMI patients predominantly managed invasively, there was no evidence that fondaparinux was superior to low molecular weight heparin with regards to ischemic events, bleeding or one-year mortality.
- © 2013 by American Heart Association, Inc.