Key result
Pre-hospital heparin administration in STEMI patients was associated with a lower rate of TIMI 0 or 1 flow in the infarct-related artery compared to no heparin (66% vs. 76%, P<0.001).
Why the study?
This study evaluated whether pre-hospital heparin administration by paramedics is safe and improves clinical outcomes in patients with STEMI undergoing primary PCI.
Does pre-hospital heparin administration by paramedics improve angiographic and clinical outcomes in patients undergoing primary PCI for STEMI?
Cohort (n=4,720)
Yes
Does pre-hospital heparin administration by paramedics improve angiographic and clinical outcomes in patients undergoing primary PCI for STEMI?
Absolute Event Rate: 66% vs 76%
p-value: p=<0.001
Pre-hospital heparin administration by paramedics for STEMI is safe and improves initial infarct-related artery patency prior to primary PCI, though it did not significantly alter 30-day clinical outcomes in this cohort.
Pre-hospital heparin may be considered in STEMI networks; leaves open whether it improves hard outcomes in randomized trials.
AIMS: This study aims to evaluate if pre-hospital heparin administration by paramedics is safe and improves clinical outcomes. METHODS AND RESULTS: Using the multicentre Victorian Cardiac Outcomes Registry, linked with state-wide ambulance records, we identified consecutive patients undergoing primary percutaneous coronary intervention for STEMI between January 2014 and December 2018. Information on thrombolysis in myocardial infarction (TIMI) flow at angiography was available in a subset of cases. Patients receiving pre-hospital heparin were compared to those who did not receive heparin. Findings at coronary angiography and 30-day clinical outcomes were compared between groups. Propensity-score matching was performed for risk adjustment. We identified a total of 4720 patients. Of these, 1967 patients had TIMI flow data available. Propensity-score matching in the entire cohort yielded 1373 matched pairs. In the matched cohort, there was no observed difference in 30-day mortality (no-heparin 3.5% vs. heparin 3.0%, P = 0.25), MACCE (no-heparin 7% vs. heparin 6.2%, P = 0.44), and major bleeding (no-heparin 1.9% vs. heparin 1.4%, P = 0.64) between groups. Propensity-score analysis amongst those with TIMI data produced 552 matched pairs. The proportion of cases with TIMI 0 or 1 flow in the infarct-related artery (IRA) was lower among those receiving pre-hospital heparin (66% vs. 76%, P < 0.001) compared to those who did not. CONCLUSION: In this multicentre, propensity-score matched study, the use of pre-hospital heparin by paramedics was safe and is associated with fewer occluded IRAs in patients presenting with STEMI.
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Bloom et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=4,720). Pre-hospital heparin vs. No pre-hospital heparin was evaluated on TIMI 0 or 1 flow in the infarct-related artery (IRA) (p=<0.001). Pre-hospital heparin administration in STEMI patients was associated with a lower rate of TIMI 0 or 1 flow in the infarct-related artery compared to no heparin (66% vs. 76%, P<0.001).
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