Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40

Introduction: Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. Methods: This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. Results: The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; P = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man (P = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Conclusion: Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.

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Age and gender differences in medical adherence after myocardial infarction: Women do not receive optimal treatment – The Netherlands claims database

European Journal of Preventive Cardiology ◽

10.1177/2047487317744363 ◽

2017 ◽

Vol 25 (2) ◽

pp. 181-189 ◽

Cited By ~ 28

Author(s):

Daniëlle C Eindhoven ◽

Alexander D Hilt ◽

Thomas C Zwaan ◽

Martin J Schalij ◽

C Jan Willem Borleffs

Keyword(s):

Myocardial Infarction ◽

Gender Differences ◽

Medical Adherence ◽

Age And Gender ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Age And Gender Differences ◽

And Gender ◽

One Year

Background Following myocardial infarction, medication is, besides lifestyle interventions, the cornerstone treatment to improve survival and minimize the occurrence of new cardiovascular events. Still, data on nationwide medication adherence are scarce. This study assesses medical adherence during one year following myocardial infarction, stratifying per type of infarct, age and gender. Design Retrospective cohort study. Methods In The Netherlands, all inhabitants are by law obliged to have health insurance and all claims data are centrally registered. In 2012 and 2013, all national diagnosis-codings of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were acquired. Furthermore, information on retrieved medication was extracted from the Dutch Pharmacy Information System. Twelve months after discharge, the retrieved medication at the pharmacy of each pharmacological therapy (aspirin-species, P2Y12-inhibitor, statin, beta-blocker, angiotensin-converting enzyme-/angiotensin 2-inhibitor, vitamin-K antagonists or novel oral anticoagulant) were analysed. Results In total, 59,534 patients (67 ± 13 years, 39,545 (66%) male, 57% NSTEMI) were included, of whom 52,672 (88%) patients were analysed for one-year medical adherence. STEMI patients more often achieved optimal medical adherence than NSTEMI patients (60% vs. 40%, p ≤ 0.001). In both STEMI and NSTEMI, use of all five indicated drugs was higher in male patients compared with female (STEMI male 61% vs. female 57%, p ≤ 0.001; NSTEMI male 43% vs. female 37%, p ≤ 0.001. With increasing age, a gradual decrease was observed in the use of aspirin, P2Y12-inhibitors and statins. Conclusion Age and gender differences existed in medical adherence after myocardial infarction. Medical adherence was lower in women, young patients and elderly patients, specifically in NSTEMI patients.

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P3622Demographic and clinical characteristics of atrial fibrillation patients suffering from an ACS without prior revascularization history

European Heart Journal ◽

10.1093/eurheartj/ehz745.0480 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Coner ◽

E Saracoglu ◽

A Akdeniz ◽

H Ozkan ◽

K Tuluce ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Coronary Artery ◽

Clinical Characteristics ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Study Population

Abstract Background The incidence of atrial fibrillation in acute coronary syndromes (ACS) ranges from 3% to 25%. The purpose of the current study was to investigate the demographic and baseline clinical characteristics, cardiovascular risk factors and comorbid conditions between patients (pts) with concomitant atrial fibrillation (AF) to those without AF in patients suffering from ACS without previous coronary artery bypass graft (CABG) and/or percutaneous coronary intervention. Methods The MINOCA-TR study has a cross-sectional, multicenter, observational design and was conducted with 32 interventional cardiology centers in our country. Heart rhythm at emergency admission, demographical, clinical and angiographic data was recorded for each patient. Patients with stable coronary artery disease, unstable angina pectoris and with type 4/5 myocardial infarction were excluded from study population. Results A total of 1626 patients (male: 70.7%, mean age: 61.4±12.5 years) were classified according to the presence of AF. The rate of AF was 3.1% in study population. This group was older (73.4 vs. 61.0 years, p<0.001) and AF was more common among females (43.1% vs. 28.7%, p=0.027). The frequency of AF was slightly higher (7.8%) in MINOCA group (p=ns). STEMI presentation was more common in patients without AF (31.3% vs. 46.9%, p=0.028). LVEF was significantly lower in ACS patients with AF (44.1% vs. 49.4%, p=0.039). The frequency of AF was significantly higher (3.7%) in MINOCA group. AF vs. non-AF ACS pts w/o prior revasc Parameter ACS with AF ACS without AF p value Age (years) 73.4 (±9.4) 61.0 (±12.4) <0.001 Female (%) 43.1 28.7 0.027 cTnT levels (pg/dL) median (IQR) 15.2 (96) 15.3 (428) 0.421 STEMI (%) 31.3 46.9 0.028 LVEF (%) 44.1 (±12.2) 49.4 (±10.4) 0.039 MINOCA (%) 7.8 6.6 0.743 STEMI: ST-segment elevation MI; NSTEMI: Non-ST-segment elevation myocardial infarction; LVEF: left ventricular ejection fraction; MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries. Conclusions The frequency of AF was relatively lower in patients suffering from an ACS without prior revascularization history. They were older than patients without AF and were common in females. Non-ST-segment elevation myocardial infarction was significantly higher in the AF. The presence of MINOCA was similar between 2 groups.

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ST-segment elevation myocardial infarction: are women being discriminated?

European Heart Journal ◽

10.1093/eurheartj/ehab724.2789 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C C Oliveira ◽

F Vilela ◽

R Flores ◽

P Medeiros ◽

C Pires ◽

...

Keyword(s):

Myocardial Infarction ◽

Gender Differences ◽

Gender Disparity ◽

Clinical Severity ◽

Primary Pci ◽

Killip Class ◽

St Segment Elevation ◽

P2y12 Inhibitors ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Background Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI) have improved, a gender disparity exists, with women showing higher mortality. Objectives To assess gender differences in presentation, management and in-hospital, at 30-days, 6-months and 1-year after STEMI mortality. Methods We collected data from 809 consecutive patients treated with primary PCI and compared the females versus males. Results Women were older than man (69,1±14,6 vs. 58,5±12,7 years; p<0.001) with higher prevalence of age over 75 years (36.7% vs. 11.7%; p<0.001), diabetes (30,6% vs. 18,5%; p=0.001), hypertension (60.5% vs. 45.9%; p=0.001), chronic kidney disease (3.4% vs. 0.6%; p=0.010) and acute ischemic stroke (6.8% vs. 3.0%; p=0.021). At presentation, women had more atypical symptoms, less chest pain (90.3% vs. 95.6%; p=0.014) and greater clinical severity (cardiogenic shock (10.7% vs. 5.4%; p=0.011). There were no differences in the symptom-first medical contact me (95.0 min vs. 80.5 min; p=0.215); however, women had longer time until reperfusion (264.0 min vs. 212.5 min; p=0.001) and were less likely to receive optimal medical therapy (aspirin-93.1% vs. 99.2%; p<0.001; P2Y12 inhibitors 91.9% vs. 98.2%; p<0.001; beta-blockers-90.8% vs. 95.1%; p=0.032; ACEIs- 88.1% vs. 94.8%; p=0.003). In-hospital mortality (9.6% vs. 3.5%; p=0.001), at 30-days (11.3% vs. 4.0%; p<0.001), 6-months (14.1% vs. 4.7%; p<0.001) and 1-year (16.4% vs. 6.3%; p<0.001) was significantly higher in women. The multivariate analysis identified age over 75 years (HR=4.25; 95% CI [1.67–10.77]; p=0.002), Killip class II (HR=8.80; 95% CI [2.72–28.41]; p<0.001), III (HR=5.88; 95% CI [0.99–34.80]; p=0.051) and IV (HR=9.60; 95% CI [1.86–48.59]; p=0.007), acute kidney injury (HR=2.47; 95% CI [1.00–6.13]; p=0.051) and days of hospitalization (HR=1.04; 95% CI [1.01–1.08]; p=0.030) but not female gender (HR=0.83; 95% CI [0.33–2.10]; p=0.690) as independent prognostic factors of mortality. Conclusions Compared to men, women with STEMI undergoing primary PCI have higher mortality rates. Our results suggest that this is not due to the gender itself, but due to the women worse risk profile, the higher reperfusion time related with system delays and the minor probability of receiving the recommended therapy. Efforts should be made to reduce these gender differences. FUNDunding Acknowledgement Type of funding sources: None.

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Gender differences in patient and system delay for primary percutaneous coronary intervention: current trends in a Swiss ST-segment elevation myocardial infarction population

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618810410 ◽

2018 ◽

Vol 8 (3) ◽

pp. 283-290 ◽

Cited By ~ 11

Author(s):

Matthias R Meyer ◽

Alain M Bernheim ◽

David J Kurz ◽

Crochan J O’Sullivan ◽

David Tüller ◽

...

Keyword(s):

Myocardial Infarction ◽

Gender Differences ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

System Delay ◽

Killip Class ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary

Background: Women with ST-segment elevation myocardial infarction (STEMI) experience greater delays for percutaneous coronary intervention-facilitated reperfusion than men. Whether women and men benefit equally from current strategies to reduce ischaemic time and whether there are gender differences in factors determining delays is unclear. Methods: Patient delay (symptom onset to first medical contact) and system delay (first medical contact to percutaneous coronary intervention-facilitated reperfusion) were compared between women ( n=967) and men ( n=3393) in a Swiss STEMI treatment network. Trends from 2000 to 2016 were analysed, with additional comparisons between three time periods (2000–2005, 2006–2011 and 2012–2016). Factors predicting delays and hospital mortality were determined by multivariate regression modelling. Results: Female gender was independently associated with greater patient delay ( P=0.02 vs. men), accounting for a 12% greater total ischaemic time among women in 2012–2016 (median 215 vs. 192 minutes, P<0.001 vs. men). From 2000–2005 to 2012–2016, median system delay was reduced by 18 and 25 minutes in women and men, respectively ( P<0.0001 for trend, P=n.s. for gender difference). Total occlusion of the culprit artery, stent thrombosis, a Killip class of 3 or greater, and presentation during off-hours predicted delays in men, but not in women. A Killip class of 3 or greater and age, but not gender or delays, were independently associated with hospital mortality. Conclusions: STEMI-related ischaemic time in women remains greater than in men due to persistently greater patient delays. In contrast to men, clinical signs of ongoing chest discomfort do not predict delays in women, suggesting that female STEMI patients are less likely to attribute symptoms to a condition requiring urgent treatment.

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Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3167 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Arroyo-Espliguero ◽

M.C Viana-Llamas ◽

A Silva-Obregon ◽

A Estrella-Alonso ◽

C Marian-Crespo ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Primary Angioplasty ◽

Prognostic Impact ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Kaplan Meier ◽

St Segment ◽

One Year ◽

The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

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The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01889-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuai Meng ◽

Yong Zhu ◽

Kesen Liu ◽

Ruofei Jia ◽

Jing Nan ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Stress Hyperglycaemia ◽

St Segment ◽

Significant Difference ◽

First Time

Abstract Background Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling. Methods We recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively. Results In the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p = 0.007). Conclusions In the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.

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Correlation between procollagen propeptides end echocardiography indices in patients with ST segment elevation myocardial infarction (STEMI)

European Heart Journal ◽

10.1093/ehjci/ehaa946.0898 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Osokina ◽

V.N Karetnikova ◽

O.M Polikutina ◽

Y.S Slepynina ◽

T.P Artemova ◽

...

Keyword(s):

Myocardial Infarction ◽

Myocardial Contractility ◽

Imaging System ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Enzyme Linked Immunosorbent Assay ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Objective To investigate the correlation between Procollagen I C-Terminal Propeptide (PICP), Procollagen III N-Terminal Propeptide (PIIINP), indices of echocardiography and anamnestic data in patients with ST segment elevation myocardial infarction (STEMI) and preserved myocardial contractility. Materials and methods 60 men and 23 women diagnosed with STEMI were examined. Echocardiographic studies were performed using SONOS 2500 Cardiac – Vascular Ultrasound (Hewlett Packard, USA). Myocardial contractility was considered to be preserved with left ventricular ejection fraction (LVEF) ≥50%. In addition to standard indices of echocardiography, mitral flow propagation velocity (FPV) was evaluated to diagnose diastolic dysfunction. Coronary angiography was performed using INNOVA 3100 Cardiovascular Imaging System (USA). All patients, during the first twelve hours of the disease, underwent percutaneous coronary intervention (PCI) with stenting of the occluded culprit infarct-related artery. On the 1st and 12th days of hospitalization, the concentrations of PICP and PIIINP were determined for all patients by enzyme-linked immunosorbent assay (ELISA) using laboratory BCM Diagnostics kits (USA). All patients at the hospital received standard therapy. Results The following marker values were obtained: 1st day: PICP 609 (583; 635) ng/ml, PIIINP 26 (18.9; 34.9) ng/ml; 12th day: PICP 588 (580; 561) ng/ml, PIIINP 24.2 (18.6; 30.3) ng/ml. The following significant correlations were revealed: PICP 1st day / isovolumic contraction time – IVCT (m/s) 12th day, r=−0.68, p=0.042; PICP 1st day / Tei Index 12th day, r=−0.72, p=0.028; PICP 1st day / diastolic rigidity 12th day, r=−0.74, p=0.021; PIIINP 1st day/age, r=0.55, p=0.016; PIIINP 1st day/ body mass index (BMI), r=−0.59, p=0.009; PIIINP 1st day / E (cm/s) 1st day, r=0.72, p=0.018; PIIINP 1st day / Em /FPV 1st day, r=0.78, p=0.007; PIIINP 12th day / Em / FPV 1st day, r=0.65, p=0.041; PIIINP 12th day / E (cm/s) 1st day, r=0.67, p=0.033; PIIINP 12th day / E / Em) 12th day, r=0.70, p=0.023; PIIINP 12th day / Em/FPV 12th day, r=0.73, p=0.014. Conclusions The data obtained indicates the correlation between serum markers of myocardial fibrosis and the indices of echocardiography, as well as age. We conclude that, all the markers listed above, are able to represent myocardial remodeling in patients with STEMI. Funding Acknowledgement Type of funding source: None

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Abstract 12762: Clinical Characteristics and Determinants of Non-Eligibility for Reperfusion in Patients With ST Segment Elevation Myocardial Infarction: Insights From the NCDR®

Circulation ◽

10.1161/circ.130.suppl_2.12762 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tarun W Dasari ◽

Steve Hamilton ◽

Anita Y Chen ◽

Tracy Y Wang ◽

James A de Lemos ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Characteristics ◽

Major Contributor ◽

Primary Pci ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Vessel Disease ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

St Elevation

Background: There is little recent data describing the characteristics and outcomes of STEMI patients who do not undergo urgent reperfusion. Methods: Using the ACTION Registry®-GWTG™ database, we examined 232,208 STEMI patients presenting January 2007 through December 2013 at 793 U.S. centers. The cohort was divided into those who underwent reperfusion (n=194,916; 84%), had documented contraindication to reperfusion (n=31,518; 13.5%) and were eligible but not reperfused (n=5,774; 2.5%). Clinical characteristics and in-hospital outcomes were compared between these groups. Results: Compared with those reperfused, patients not reperfused were older, more often female and had higher rates of hypertension, diabetes, MI, stroke and atrial fibrillation. LBBB and CHF were more common in the non-reperfused groups upon presentation. The major documented contraindications to reperfusion were unsuitable anatomy for primary PCI (31%), symptoms onset > 12 hours (9%), patient/family refusal/DNR status (6%), resolved chest pain (6%) and ST elevation (5%) presentation to non-PCI centers (4%). Three-vessel disease and in-hospital CABG were more common in non-reperfused patients with and without contraindication compared with those receiving reperfusion (39 & 37% vs. 26%, p<0.001) and (17 & 17% vs. 3%, p<0.001 respectively). In-hospital outcomes are summarized in the table. Conclusion: Most STEMI patients who were not reperfused had a documented contraindication. Unsuitable anatomy for PCI was the major contributor to ineligibility. In hospital mortality, death/MI and cardiogenic shock were higher in the non-reperfused groups.

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Abstract 16476: Safety Profile of Bivalirudin in the Treatment of ST-Segment Elevation Myocardial Infarction Patients in Clinical Practice - Results From the Bremen STEMI Registry

Circulation ◽

10.1161/circ.130.suppl_2.16476 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Robert Zabrocki ◽

Eduard Fiehn ◽

Harm Wienbergen ◽

Susanne Seide ◽

Johannes Schmucker ◽

...

Keyword(s):

Myocardial Infarction ◽

Safety Profile ◽

Real World Data ◽

Killip Class ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

All Cause Mortality ◽

Heart Center ◽

Current Guidelines

Introduction: Previous studies demonstrated that treatment of patients (pts) being affected by ST-segment elevation myocardial infarction (STEMI) with bivalirudin (biv) instead of heparin (hep) reduced rates of major bleedings. Results regarding a reduction in all-cause mortality are inconclusive, stent thromboses however were slightly increased. Real world data in pts with STEMI treated with biv in the era of new anti-thrombotic treatment are still spare. The aim of this study was to evaluate safety of biv for all-comers. Methods: All pts with STEMI from the metropolitan area of Bremen (Germany) are admitted to the Bremen heart center and documented in the Bremen STEMI-registry (BSR) since 2006. In May 2013 we adapted our anticoagulation strategy to the current guidelines from hep with glycoprotein IIb/IIIa inhibitors (GPI) to biv with provisional use of GPI. Pts receiving biv were compared to all pts until April 2013 in the BSR without chronic renal failure. Results: Baseline and interventional characteristics of 530 consecutive pts treated with biv and 5197 pts treated with hep are shown in table 1. Despite a higher portion of pts after resuscitation (10.3% vs 8.6%; p<0.01) and a higher incidence of Killip class 3 or 4 (15% vs 8%; p<0.001) in the biv group inhospital all-cause mortality showed no difference (biv: 6.8% vs hep: 7.3%, p=0.66). However pts treated with biv demonstrated highly significant lower bleeding rates (TIMI major/minor bleedings: 0.8% vs 3.7%, p<.01). Stent-thromboses showed a trend towards an increased event rate with biv (1.3%, 7pts vs 1.0%, 52pts, p=0.07). Conclusions: In one of the largest all-comers registries treatment with biv was associated with significantly lower minor and major bleedings. There is only a trend for a higher rate of stent thromboses in the biv group. Therefore, data from our all-comers registry support the beneficial safety profile of biv observed in clinical studies.

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