Key result
Administration of bolus unfractionated heparin in the emergency room before primary PCI significantly increased the rate of improved left ventricular ejection fraction compared to administration during PCI (28.1% vs. 9.7%, p=0.005).
Why the study?
Does bolus unfractionated heparin administered in the emergency room before primary PCI improve clinical outcomes and left ventricular function in patients with STEMI?
RCT (n=196)
Randomly assigned
No
Does bolus unfractionated heparin administered in the emergency room before primary PCI improve clinical outcomes and left ventricular function in patients with STEMI?
Absolute Event Rate: 28.1% vs 9.7%
p-value: p=0.005
Early administration of bolus unfractionated heparin in the emergency room before primary PCI for STEMI improves left ventricular ejection fraction recovery without significantly increasing bleeding or affecting 30-day mortality.
Supports early ER heparin bolus to enhance LVEF recovery in STEMI; extends pre-PCI anticoagulation timing evidence.
Background: Primary PCI (PPCI) is the main reperfusion treatment for ST-segment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI.Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02±13.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups.Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups.Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.
No takes yet. Share an insight, caveat, or question.
Zamani et al. (2018) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=196). Bolus unfractionated heparin in emergency room vs. Bolus unfractionated heparin during PCI was evaluated on Improved left ventricular ejection fraction (LVEF) during follow-up (p=0.005). Administration of bolus unfractionated heparin in the emergency room before primary PCI significantly increased the rate of improved left ventricular ejection fraction compared to administration during PCI (28.1% vs. 9.7%, p=0.005).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: