Introduction Primary Percutaneous Coronary Intervention (PPCI) for acute ST-Elevation Myocardial Infarction (STEMI) is increasingly concerned about in situ thrombosis. Endothelial dysfunction is the cause of vasomotor dysfunction and inflammation. Risk factors include the stent, procedure, lesion, and patient-specific difficulties. The aim is to assess the Major Adverse Cardiac Events (MACE) and bleeding events among acute STEMI Killip 1 patients with and without post-PPCI anticoagulation therapy.

Method This retrospective observational analysis included 238 acute STEMI Killip 1 patients from two Malaysian tertiary institutions who received PPCI between 2017 and 2019. Compare risk factors, mortality, revascularisation, cardiogenic shock, heart failure, and bleeding events of standard post-PPCI anticoagulant therapy to those not treated.

Results After PPCI, 86 patients (36%) received anticoagulants, while 152 did not. Bleeding episodes were significantly associated with urea, creatinine, low-density lipoprotein (LDL), damaged arteries, drug-eluting stent (DES) insertion, and anticoagulant duration (P < 0.05). Cardiogenic shock was linked to STEMI diagnosis, heart rate, and platelet count (P = 0.037–0.023). Additionally, substantial correlations exist between diastolic blood pressure (P < 0.01), HbA1C (P = 0.003), and revascularisation (P < 0.05). Additionally, haemoglobin, platelet count, urea, creatinine, and HbA1C were linked to death and heart failure (P < 0.05). Two patients (2.3%) in the anticoagulants group underwent revascularisation, but angiograms showed no stent thrombosis, while just one patient (0.7%) in the non-anticoagulants group needed revascularisation.

Discussion This study discovered comparable baseline characteristics and angiogram findings between anticoagulant and non-anticoagulant groups. These findings also suggest that close monitoring and early intervention in patients with high heart rates and abnormal platelet counts could be critical in preventing cardiogenic shock. Healthcare providers should prioritise early intervention and meticulous management of heart rate, platelet count, and HbA1C levels in STEMI patients to reduce the risk of cardiogenic shock and other complications.

Conclusion After PPCI, anticoagulation did not enhance mortality or revascularisation. Routine anticoagulation after PPCI did not increase bleeding. This shows that while anticoagulant medication may decrease stent-related problems without raising bleeding risks, its overall benefit in post-PPCI outcomes is unclear, requiring more diversified studies.