Post Procedural Anticoagulation After Percutaneous Coronary Intervention in Patients With St-segment Elevation Myocardial Infarction : a Systematic Review and Meta-analysis

Purpose: This meta-analysis aims to evaluate the post-procedural anticoagulation in patients with ST-segment elevation after percutaneous coronary intervention Methods: A systematic review and meta-analysis search was conducted in the PubMed, Scoups, Embase, and Cochrane databases to identify relevant trials and cohort studies adhering and following the PRISMA established guidelines. The inclusion criteria covered studies that evaluate the use of PPA in STEMI patients after PCI, the exclusion criteria was studies that used the anticoagulation before and periprocedural and patients that underwent coronary artery bypass grafting. The main outcomes analyzed were all-cause mortality, cardiac death, reinfarction, stent thrombosis and stroke, comparing the group that used anticoagulation and the control group. Statistical analysis was performed using R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria) under the random-effects model to estimate pooled outcomes and assess heterogeneity. Results: Across the included studies, no statistically significant differences were observed between postprocedural anticoagulation (AC) and no anticoagulation (NAC) in any of the evaluated outcomes. For all-cause mortality (9 studies; 39,915 AC vs. 24,208 NAC), the pooled risk ratio (RR) was 0.76 [95% CI: 0.54–1.07; p = 0.1168; I² = 77.1%]. Cardiac death (6 studies; 32,523 AC vs. 17,190 NAC) showed an RR of 0.72 [95% CI: 0.49–1.05; p = 0.0906; I² = 77.7%]. Reinfarction (8 studies; 39,747 AC vs. 23,950 NAC) had an RR of 0.79 [95% CI: 0.48–1.31; p = 0.3657; I² = 82.3%]. For stent thrombosis (8 studies; 39,747 AC vs. 23,946 NAC), the RR was 1.17 [95% CI: 0.91–1.49; p = 0.2160; I² = 18.0%]. Stroke (8 studies; 39,839 AC vs. 24,116 NAC) showed an RR of 1.07 [95% CI: 0.75–1.51; p = 0.7170; I² = 29.1%], and bleeding (8 studies; 32,741 AC vs. 17,475 NAC) showed an RR of 0.96 [95% CI: 0.60–1.53; p = 0.8603; I² = 89.5%]. Finally, major adverse cardiovascular events (MACE) (6 studies; 32,523 AC vs. 17,186 NAC) had an RR of 0.71 [95% CI: 0.43–1.18; p = 0.1899; I² = 92.6%]. Conclusion: This meta-analysis shows that routine anticoagulation after primary PCI does not significantly reduce cardiovascular events, likely due to effective antiplatelet therapy and procedural advances. The findings align with current guidelines discouraging its routine use. A personalized approach remains essential to balance ischemic and bleeding risks.