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Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI
Vlad Bataila1, Nicoleta-Monica Popa-Fotea1,2, Cosmin Cojocaru1,2
1Department of Cardiology, Clinical Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania.
Insights
Early heparin administration in ST-segment elevation myocardial infarction (STEMI) patients improves infarct-related artery patency before primary percutaneous coronary intervention (pPCI). This approach enhances stent implantation without increasing bleeding risks or mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of global morbidity and mortality.
- Primary percutaneous coronary intervention (pPCI) is the standard treatment for STEMI, requiring anticoagulation, typically with heparin.
- Optimal timing for heparin administration in STEMI patients undergoing pPCI remains unclear.
Purpose of the Study:
- To investigate the impact of early heparin administration on infarct-related artery (IRA) patency and outcomes in STEMI patients.
- To compare outcomes between STEMI patients receiving heparin at first medical contact versus those receiving it at the PCI-capable center.
Main Methods:
- A multicenter observational study included 614 consecutive STEMI patients treated between 2017 and 2019.
- Patients were divided into two groups: early heparin (at first medical contact) and on-site heparin (at PCI-capable center/cath lab).
- Outcomes assessed included IRA patency, stent implantation parameters, bleeding rates, and in-hospital/two-year mortality.
Main Results:
- Early heparin administration was associated with a significantly higher rate of IRA patency at coronary angiography (44.7% vs. 37.3%, p=0.042).
- Patients receiving early heparin had improved stent implantation parameters, including shorter and wider stents.
- No significant differences were observed in bleeding rates or in-hospital and two-year mortality between the groups.
Conclusions:
- Early heparin administration in STEMI patients enhances pre-pPCI IRA reperfusion.
- This strategy leads to improved stent implantation parameters without an increase in bleeding complications.
- Early heparin administration is a beneficial adjunct in the management of STEMI patients undergoing pPCI.
Abstract:
(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.
