Abstract:
AIMS:Initial thrombolysis in myocardial infarction (TIMI) flow and mortality are related in ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty (PPCI). It is unclear whether early adjunctive treatment with unfractionated heparin (UFH) is beneficial for coronary patency. We investigated the effect of UFH administered before transfer versus in the catheterization laboratory (CathLab) on initial patency of the infarct related artery (IRA) in transferred STEMI patients treated with PPCI. METHODS AND RESULTS:Consecutive STEMI patients (n=1326, February 2007-December 2013) were allocated in two groups relative to UFH administration: pre-transfer group - administration by ambulance crew or physician-in-charge at the non-PPCI centre, 758 patients (57%); post-transfer group - administration in the CathLab, 568 patients (43%). The time range between symptom onset (SO) and UFH administration (SO-UFH) was assessed and the 1-year mortality prediction was analysed by logistic regression. Initial IRA TIMI 2-3 flow was 30.3% in pre-transfer group vs. 21.2% in post-transfer group (p<0.001). A time-dependent association was found between SO-UFH and initial TIMI 2-3 in pre- vs. post-transfer groups [<120 min: 33.2% vs. 18%, p<0.001; 120-240 min: 29.2% vs. 22.8%, p=0.18; >240 min: 25% vs. 28%, p=0.57]. No differences in major bleeding were found between groups. UFH administration before transfer remained an independent predictor for initial TIMI 2-3 flow (OR 1.60 CI 95% 1.22-2.11, p=0.01) and for 1-year mortality (OR 0.51 CI 95% 0.29-0.91, p=0.02). CONCLUSIONS:Early UFH administration in STEMI patients transferred for PPCI results in higher IRA initial patency in a time-dependent manner and improves clinical outcomes.
journal_name
Int J Cardioljournal_title
International journal of cardiologyauthors
Giralt T,Carrillo X,Rodriguez-Leor O,Fernandez-Nofrerias E,Rueda F,Serra-Flores J,Viguer JM,Mauri J,Curos A,Bayes-Genis Adoi
10.1016/j.ijcard.2015.06.009subject
Has Abstractpub_date
2015-11-01 00:00:00pages
70-4eissn
0167-5273issn
1874-1754pii
S0167-5273(15)01310-8journal_volume
198pub_type
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journal_title:International journal of cardiology
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