ESC 23 — Dr Yan Yan (Beijing Anzhen Hospital, CN) and Prof Gilles Montalescot (Pitie Salpetriere APHP University Hospital, FR) discusses the findings from a comparison of anticoagulation prolongation vs no anticoagulation in STEMI patients post-primary PCI (RIGHT) (NCT03664180). 

The RIGHT study (Beijing Anzhen Hospital) aimed to evaluate the clinical efficacy and safety of anticoagulation prolonged to 48 hours post-primary percutaneous coronary intervention (PPCI) as compared to no prolongation of anticoagulation after procedure in patients with ST-elevation myocardial infarction (STEMI). 2989 patients were enrolled in the trial, and were randomized to receive either unfractionated heparin, enoxaparin or bivalirudin 48 hours after PCI.

Results suggest that anticoagulation after primary PCI is safe, but does not reduce ischaemic events in low to intermediate-risk patients with STEMI.

Questions:

1. What do we know about anticoagulation after primary percutaneous coronary intervention (pPCI)?
2. What is the rationale behind a 48-hour delay in anticoagulation, in terms of the mechanism of action?
3. What was the study design and the patient population?
4. What are the key findings presented at the European Society of Cardiology (ESC)?
5. What are the take-home messages? How should this data influence guidelines?
6. What are the next steps?

Recorded on-site at ESC Congress 2023, Amsterdam. 

Editors: Mirjam Boros and Jordan Rance

Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles