Prehospital Heparin Administration in Patients With STEMI Undergoing Primary PCI: HEPARIN-STEMI Randomized Controlled...

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• Primary percutaneous coronary intervention (PCI) is the standard reperfusion therapy for ST-elevation myocardial infarction (STEMI).
• Optimizing reperfusion and safety in STEMI patients undergoing primary PCI remains a critical clinical challenge.
• The role of prehospital interventions in improving outcomes for STEMI is an active area of research.

Purpose of the Study:

• To evaluate the efficacy and safety of unfractionated heparin (UFH) pretreatment in STEMI patients referred for primary PCI.
• To determine if early UFH administration improves coronary artery patency compared to standard UFH timing.
• To assess the impact of UFH pretreatment on bleeding complications in STEMI patients.

Main Methods:

• A single-center, open-label, randomized controlled trial was conducted.
• STEMI patients within 6 hours of symptom onset were randomized to receive UFH at first prehospital medical contact or standard UFH during PCI.
• The primary efficacy endpoint was TIMI 2-3 flow in the infarct-related artery (IRA); the primary safety endpoint was BARC 3-5 bleeding.

Main Results:

• 43% of patients receiving UFH pretreatment achieved TIMI 2-3 flow versus 27% in the control group (p<0.001).
• UFH pretreatment demonstrated a significant increase in IRA patency (RR 1.59).
• No significant difference in BARC 3-5 bleeding was observed between the UFH pretreatment and control groups (2.4% vs 2.0%; p=0.789).

Conclusions:

• Pretreatment with UFH at first medical contact in STEMI patients undergoing primary PCI significantly increases IRA patency.
• This early UFH administration is associated with an absolute 16% increase in IRA patency.
• UFH pretreatment is a safe strategy, not leading to excessive bleeding in STEMI patients within a mature STEMI network.