Key result
Prehospital administration of unfractionated heparin in STEMI patients was associated with significantly lower 30-day mortality compared to in-hospital heparin (2.5% vs 8.3%; OR 0.33, 95% CI 0.17-0.66).
Why the study?
Ambulance administration of unfractionated heparin to STEMI patients is established practice in Scotland, but its efficacy remains unknown.
Does prehospital administration of unfractionated heparin improve survival and infarct artery patency in STEMI patients undergoing primary PCI compared to in-hospital administration?
Cohort (n=1,000)
No
Does prehospital administration of unfractionated heparin improve survival and infarct artery patency in STEMI patients undergoing primary PCI compared to in-hospital administration?
Odds Ratio: 0.33 (95% CI 0.17–0.66)
Absolute Event Rate: 2.5% vs 8.3%
p-value: p=<0.001
Prehospital administration of unfractionated heparin in STEMI patients undergoing primary PCI is associated with significantly improved short- and long-term survival compared to in-hospital administration.
Prehospital heparin was associated with lower STEMI mortality; leaves open whether randomized trials should test routine ambulance use.
OBJECTIVE: Administration of unfractionated heparin to STEMI patients by the ambulance service is an established practice in Scotland, but the efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention, on infarct artery patency and mortality. METHODS AND RESULTS: Consecutive patients (n = 1000) admitted to Ninewells Hospital, Dundee, from 2010 to 2014 for primary percutaneous coronary intervention were allocated to 2 groups: 437 (44%) prehospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin. A trained medical student assessed coronary flow at presentation and collected the data. Mortality status was ascertained at 30 days and 5 years. Cox proportional hazards regression models were generated. The patient groups were similar, although PHH had shorter symptom onset-treatment time (187 vs. 251 minutes, P < 0.001) and less cardiogenic shock (3.9% vs. 8.0%, P = 0.008). Initial coronary flow was not different between the groups. Thirty day mortality in PHH was 2.5% versus 8.3%, P < 0.001. Independent predictors of 30-day mortality were age (odds ratio 1.07, 95% CI 1.04-1.09), cardiogenic shock (5.97, 3.33-10.69), radial access (0.53, 0.28-0.98), and PHH (0.33, 0.17-0.66). Five-year mortality in PHH was 13.0% versus 21.6%, P < 0.001. Significant predictors of long-term mortality were age (1.07, 1.06-1.09), cardiogenic shock (3.40, 2.23-5.17), and PHH (0.68, 0.49-0.96). CONCLUSIONS: PHH was associated with reduced short- and long-term mortality after adjusting for important potential confounders.
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McGinley et al. (2020) conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=1,000). Prehospital administration of unfractionated heparin vs. In-hospital heparin was evaluated on 30-day mortality (OR 0.33, 95% CI 0.17-0.66, p=<0.001). Prehospital administration of unfractionated heparin in STEMI patients was associated with significantly lower 30-day mortality compared to in-hospital heparin (2.5% vs 8.3%; OR 0.33, 95% CI 0.17-0.66).
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