Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation...

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Optimal timing for antithrombotic therapy in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) remains unclear.
• This study investigates the impact of pre-angioplasty unfractionated heparin (UFH) administration on infarct-related artery (IRA) patency and patient mortality.

Purpose of the Study:

• To determine the effect of pre-PPCI unfractionated heparin (UFH) timing on infarct-related artery (IRA) patency.
• To assess the association between UFH administration timing and 30-day and 1-year mortality in STEMI patients undergoing PPCI.

Main Methods:

• A multicenter prospective observational study included 3520 STEMI patients treated with PPCI between 2016 and 2018.
• Patients were stratified into four groups based on the time from UFH administration to PPCI (≤30 min, 31-60 min, 61-90 min, >90 min).
• Multivariate analyses were performed to identify factors associated with IRA patency (TIMI flow grade 2-3) and mortality.

Main Results:

• Early UFH administration (especially >60 min before PPCI) was an independent predictor of improved IRA patency (OR 1.43).
• UFH administration was also an independent predictor of reduced 30-day (HR 0.63) and 1-year (HR 0.57) mortality.
• The beneficial effect of UFH on IRA patency was more pronounced when administered earlier after symptom onset.

Conclusions:

• Pre-PPCI UFH administration at STEMI diagnosis enhances coronary reperfusion.
• This improved reperfusion is associated with superior clinical outcomes, including reduced mortality.
• The findings underscore a time-dependent effectiveness of UFH, with earlier administration yielding greater benefits.