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Unfractionated heparin (UFH) pretreatment before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) did not significantly improve outcomes or increase bleeding risk. Individual risk-benefit assessment is advised due to a lack of high-quality trial evidence.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Patients with ST-segment elevation myocardial infarction (STEMI) often receive unfractionated heparin (UFH) pretreatment before primary percutaneous coronary intervention (PPCI).
  • The clinical benefit and safety of UFH pretreatment remain debated due to conflicting study findings.
  • This study retrospectively analyzes registry data to evaluate UFH pretreatment risks and benefits in STEMI patients undergoing PPCI.

Purpose of the Study:

  • To assess the safety and efficacy of unfractionated heparin (UFH) pretreatment in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI).
  • To compare key clinical outcomes, including infarct-related artery patency, in-hospital mortality, and access-site bleeding, between STEMI patients with and without UFH pretreatment.

Main Methods:

  • Retrospective analysis of registry data from 4632 STEMI patients undergoing PPCI between 2005 and 2020.
  • Propensity score matching (PSM) was used to adjust for confounding factors, comparing 511 pretreated patients with 187 non-pretreated patients.
  • Key endpoints analyzed included infarct-related artery (IRA) patency, in-hospital mortality, access-site bleeding, and peak creatine kinase (CK) levels.

Main Results:

  • UFH pretreatment was administered to 95.4% of STEMI patients.
  • After PSM, UFH pretreatment was not significantly associated with improved IRA patency (OR 1.01 [0.59; 1.74]), reduced in-hospital mortality (OR 1.46 [0.88; 2.42]), or increased access-site bleeding (OR 0.59 [0.14; 2.46]).
  • Peak creatine kinase levels were similar between the UFH pretreated and non-pretreated groups.

Conclusions:

  • Unfractionated heparin (UFH) pretreatment in STEMI patients undergoing PPCI was not linked to significant improvements in major clinical outcomes or increased bleeding risk.
  • UFH pretreatment was less common in patients who had undergone cardiopulmonary resuscitation.
  • Given the lack of high-quality trial evidence, the decision for UFH pretreatment should be individualized, considering alternative antithrombotic strategies.