Key result
Heparin administration after primary PCI in STEMI patients significantly reduced the incidence of post-procedural TIMI flow grade 0/1 (1.0% vs 5.5%) and re-myocardial infarction (0% vs 2.5%) compared to no heparin.
Why the study?
Anticoagulation is indicated during PCI to reduce ischemic complications, but the effect of heparin administration after PCI on short-term clinical outcomes in STEMI patients required evaluation.
Does the administration of heparin after primary PCI improve short-term clinical outcomes in patients with STEMI?
RCT (n=400)
Randomly divided in two groups
No
Does the administration of heparin after primary PCI improve short-term clinical outcomes in patients with STEMI?
Absolute Event Rate: 1% vs 5.5%
p-value: p=0.034
Routine administration of heparin for 24 hours after primary PCI in STEMI patients may improve short-term outcomes including ejection fraction, re-MI, and need for revascularization without significantly increasing major bleeding.
Supports post-PCI heparin in STEMI to cut early re-MI; extends randomized anticoagulation evidence beyond the lab.
Background: Doing percutaneous coronary intervention (PCI) in the first hours of myocardial infraction (MI) is effective in re-establishment of blood flow. Anticoagulation treatment should be prescribed in patients undergoing PCI to decrease the side effects of ischemia. The aim of this study is to determine the effect of heparin prescription after PCI on short-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Materials: This randomized clinical trial study was conducted at Imam Ali cardiovascular center at Kermanshah university of medical science (KUMS), Iran. Between April 2019 to October 2019, 400 patients with STEMI which candidate to PCI were enrolled. Patients randomly divided in two groups: intervention group (received 5,000 units of heparin after PCI until first 24 hours, every 6 hours) and control group (did not receive heparin). Data were collected using a checklist developed based on the study's aims. Differences between groups were assessed using independent t-tests and chi-square (or Fisher exact tests).Result: Observed that, mean prothrombin time (PT) (13.30±1.60 vs. 12.21±1.15, p<0.001) and partial thromboplastin time (PTT) (35.30±3.08 vs. 34.41±3.01, p=0.003) were significantly higher in intervention group compared to control group. Thrombolysis in myocardial infarction (TIMI) flow grade 0/1 after primary PCI was significantly more frequently in control group (5.5% vs. 1.0%, p=0.034). The mean of ejection fraction (EF) after PCI (47.58±7.12 vs. 45.15±6.98, p<0.001) was significantly higher in intervention group. Intervention group had a statistically significant shorter length of hospital stay (4.71±1.03 vs. 6.12±1.10, p<0.001). There was higher incidence of re-vascularization (0% vs. 3.0%; p=0.013) and re-MI (0% vs. 2.5%; p=0.024) in the control group.Conclusion: Performing primary PCI with receiving heparin led to improve TIMI flow and consequently better EF. Receiving heparin is associated with lower risk of re-MI and re-vascularization.
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Rouzbahani et al. (2020) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=400). Heparin vs. No heparin was evaluated on TIMI flow grade 0/1 after primary PCI (p=0.034). Heparin administration after primary PCI in STEMI patients significantly reduced the incidence of post-procedural TIMI flow grade 0/1 (1.0% vs 5.5%) and re-myocardial infarction (0% vs 2.5%) compared to no heparin.
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