1 Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
2 Department of Medical Sciences, Uppsala University, Sweden.
Eur Heart J Acute Cardiovasc Care. 2019 Feb;8(1):15-23. doi: 10.1177/2048872617727723. Epub 2017 Sep 1.
: Pre-treatment with unfractionated heparin is common in ST-segment elevation myocardial infarction (STEMI) protocols, but the effect on intracoronary thrombus burden is unknown. We studied the effect of heparin pre-treatment on intracoronary thrombus burden and Thrombolysis in Myocardial Infarction (TIMI) flow prior to percutaneous coronary intervention in patients with STEMI.
: The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial angiographically assessed intracoronary thrombus burden and TIMI flow, prior to percutaneous coronary intervention, in patients with STEMI. In this observational sub-study, patients pre-treated with heparin were compared with patients not pre-treated with heparin. Primary end points were a visible intracoronary thrombus and total vessel occlusion prior to percutaneous coronary intervention. Secondary end points were in-hospital bleeding, in-hospital stroke and 30-day all-cause mortality.
: Heparin pre-treatment was administered in 2898 out of 7144 patients (41.0%). Patients pre-treated with heparin less often presented with an intracoronary thrombus (61.3% vs. 66.0%, p<0.001) and total vessel occlusion (62.9% vs. 71.6%, p<0.001). After adjustments, heparin pre-treatment was independently associated with a reduced risk of intracoronary thrombus (odds ratio (OR) 0.73, 95% confidence interval (CI)=0.65-0.83) and total vessel occlusion (OR 0.64, 95% CI=0.56-0.73), prior to percutaneous coronary intervention. There were no significant differences in secondary end points of in-hospital bleeding (OR 0.84, 95% CI=0.55-1.27), in-hospital stroke (OR 1.17, 95% CI=0.48-2.82) or 30-day all-cause mortality (hazard ratio 0.88, 95% CI=0.60-1.30).
: Heparin pre-treatment was independently associated with a lower risk of intracoronary thrombus and total vessel occlusion before percutaneous coronary intervention in patients with STEMI, without evident safety concerns, in this large multi-centre observational study.
在 ST 段抬高型心肌梗死（STEMI）方案中，使用未分级肝素进行预处理很常见，但对冠状动脉内血栓负荷的影响尚不清楚。我们研究了肝素预处理对 STEMI 患者经皮冠状动脉介入治疗前冠状动脉内血栓负荷和血栓溶解心肌梗死（TIMI）血流的影响。
ST 段抬高型心肌梗死在斯堪的纳维亚的血栓抽吸（TASTE）试验通过血管造影评估了 STEMI 患者经皮冠状动脉介入治疗前的冠状动脉内血栓负荷和 TIMI 血流。在这项观察性亚研究中，将接受肝素预处理的患者与未接受肝素预处理的患者进行比较。主要终点是经皮冠状动脉介入治疗前可见的冠状动脉内血栓和总血管闭塞。次要终点是院内出血、院内卒中和 30 天全因死亡率。
在 7144 例患者中，2898 例（41.0%）接受了肝素预处理。接受肝素预处理的患者冠状动脉内血栓（61.3%比 66.0%，p<0.001）和总血管闭塞（62.9%比 71.6%，p<0.001）的发生率较低。调整后，肝素预处理与经皮冠状动脉介入治疗前冠状动脉内血栓（比值比（OR）0.73，95%置信区间（CI）=0.65-0.83）和总血管闭塞（OR 0.64，95% CI=0.56-0.73）的风险降低独立相关。在院内出血（OR 0.84，95% CI=0.55-1.27）、院内卒中和 30 天全因死亡率（风险比 0.88，95% CI=0.60-1.30）的次要终点方面，无显著差异。
在这项大型多中心观察性研究中，肝素预处理与 STEMI 患者经皮冠状动脉介入治疗前冠状动脉内血栓和总血管闭塞的风险降低独立相关，无明显安全性问题。
