Key result
Unfractionated heparin pretreatment in patients with STEMI undergoing primary PCI was associated with a significantly lower risk of all-cause mortality (OR 0.61) compared to no pretreatment or delayed administration.
Why the study?
Unfractionated heparin is frequently administered before PCI in STEMI, but current guidelines lack clear recommendations regarding pretreatment before arrival at the coronary catheterisation laboratory.
Does unfractionated heparin pretreatment reduce all-cause mortality in patients with STEMI undergoing primary PCI?
Meta-Analysis (n=76,446)
Does unfractionated heparin pretreatment reduce all-cause mortality in patients with STEMI undergoing primary PCI?
Odds Ratio: 0.61 (95% CI 0.49–0.76)
p-value: p=< 0.01
Unfractionated heparin pretreatment before primary PCI in STEMI patients is associated with reduced all-cause mortality, lower rates of cardiogenic shock, and enhanced reperfusion without increasing major bleeding.
UFH pretreatment was associated with lower mortality in STEMI; supports guideline consideration but leaves open need for confirmatory RCTs.
Background Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). However, current guidelines do not provide clear recommendations for UFH pretreatment before arrival at the coronary catheterisation laboratory. Methods Between June and July 2023, we systematically searched PubMed, Embase and Cochrane databases for studies comparing UFH pretreatments in patients with STEMI. A random-effects meta-analysis and meta-regression analyses were performed. Results Fourteen studies were included, of which four were randomised clinical trials (RCTs). A total of 76446 patients were included: 31238 in the pretreatment group and 39208 in the control group. Our meta-analysis revealed a lower all-cause mortality for the pretreatment strategy when compared with the control group, albeit with high heterogeneity (pooled odds ratio (OR) = 0.61, 95% confidence interval (CI) [0.49 - 0.76], P < 0.01; I² = 77%); lower in-hospital cardiogenic shock (pooled OR = 0.68, 95% CI [0.58, 0.78], P < 0.21; I² = 27%) and a higher rate of spontaneous reperfusion events (pooled OR = 1.68, 95% CI [1.47, 1.91], P < 0.01; I² = 79%). In terms of major bleeding, the UFH pretreatment strategy further revealed a decreased rate of events (pooled OR = 0.85, 95% CI [0.73, 0.99], P = 0.40; I² = 4%). Conclusions Our study suggests that UFH pretreatment in patients with STEMI undergoing primary PCI was associated to reduced all-cause mortality, cardiogenic shock, enhancing reperfusion rates, whilst diminishing major bleeding events.
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Costa et al. (2024) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=76,446). Unfractionated heparin (UFH) pretreatment vs. No UFH pretreatment or delayed administration was evaluated on All-cause mortality (OR 0.61, 95% CI 0.49-0.76, p=< 0.01). Unfractionated heparin pretreatment in patients with STEMI undergoing primary PCI was associated with a significantly lower risk of all-cause mortality (OR 0.61) compared to no pretreatment or delayed administration.
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