Heparin pretreatment at the time of STEMI diagnosis significantly decreased 30-day death compared to intraprocedural administration (OR 0.68; 95% CI 0.54-0.86) without increasing major bleeding.
Meta-Analysis (n=72,249)
Does unfractionated heparin pretreatment reduce death and improve artery patency compared to intraprocedural administration in patients with ST-segment elevation myocardial infarction?
Heparin pretreatment at the time of STEMI diagnosis significantly reduces short- and long-term mortality and improves initial infarct-related artery patency compared to intraprocedural administration, without increasing bleeding risk.
Effect estimate: OR 0.68 (95% CI 0.54-0.86)
Abstract Objectives To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction Background There is a paucity of data regarding the best timing for heparin administration in STEMI. Methods We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. Results 11 observational studies and 4 clinical trials with a total of 72249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR=0,68; 95% CI 0.54-0.86) as well as at longer follow-up (mean follow-up time 14.4 months OR=0,61; 95% CI 0.44-0.85). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2-3) at first coronary angiography (OR=1,7; 95% CI 1.43-2.04), and did not show increase in major bleedings (OR 0.92, 95% CI 0.81-1.05) Conclusion A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complicationsMajor outcomes analysis Safety analysis
Franchin et al. (Sat,) conducted a meta-analysis in ST-segment elevation myocardial infarction (n=72,249). Heparin pretreatment vs. Intraprocedural administration was evaluated on Death at 30 days (OR 0.68, 95% CI 0.54-0.86). Heparin pretreatment at the time of STEMI diagnosis significantly decreased 30-day death compared to intraprocedural administration (OR 0.68; 95% CI 0.54-0.86) without increasing major bleeding.