Poster 107: Potent Anticoagulants in Cardiogenic Shock or Cardiac Arrest among Patients with Acute Myocardial Infarction: A Systematic Review and Meta-analysis

Background: The mortality risk is profound in Acute myocardial infarction (AMI) complicated by cardiogenic shock or arrest. The benefit of potent anticoagulants in these patients remains uncertain.

Methods: We searched electronic databases for randomized controlled trials (RCTs) and observational studies (OS). Meta-analysis was conducted in R version 4.4.3 using the “meta” and “metasens” packages. A restricted maximum likelihood random-effects model with Hartung-Knapp adjustment was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs).

Outcome: A total of 14 studies comprising 5,606 patients met the inclusion criteria. Use of potent anticoagulants was associated with a statistically significant reduction in the risk of major adverse cardiovascular events (RR: 0.84; 95% CI: 0.72–0.98), early mortality (RR: 0.83; 95% CI: 0.76–0.92), long-term mortality (RR: 0.64; 95% CI: 0.53–0.76), and myocardial reinfarction (RR: 0.64; 95% CI: 0.53–0.76). However, there was no significant difference in the risk of stent thrombosis (RR: 1.92; 95% CI: 0.97–3.81). Treatment was significantly associated with an increased risk of in-hospital major bleeding (RR: 1.47; 95% CI: 1.15–1.88). Subgroup analyses in patients with cardiogenic shock and cardiac arrest showed consistent findings within the cardiogenic shock subgroup.

Conclusion: Potent anticoagulants reduce MACE and mortality in AMI related shock but increase hemorrhage, necessitating individualized risk stratification