Bloom Jason E, Andrew Emily, Nehme Ziad, Dinh Diem T, Fernando Himawan, Shi William Y, Vriesendorp Pieter, Nanayakarra Shane, Dawson Luke P, Brennan Angela, Noaman Samer, Layland Jamie, William Jeremy, Al-Fiadh Ali, Brooks Matthew, Freeman Melanie, Hutchinson Adam, McGaw David, Van Gaal William, Willson William, White Anthony, Prakash Roshan, Reid Christopher, Lefkovits Jeffrey, Duffy Stephen J, Chan William, Kaye David M, Stephenson Michael, Bernard Stephen, Smith Karen, Stub Dion
Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia.
Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
Eur Heart J Acute Cardiovasc Care. 2021 Dec 18;10(10):1140-1147. doi: 10.1093/ehjacc/zuab032.
This study aims to evaluate if pre-hospital heparin administration by paramedics is safe and improves clinical outcomes.
Using the multicentre Victorian Cardiac Outcomes Registry, linked with state-wide ambulance records, we identified consecutive patients undergoing primary percutaneous coronary intervention for STEMI between January 2014 and December 2018. Information on thrombolysis in myocardial infarction (TIMI) flow at angiography was available in a subset of cases. Patients receiving pre-hospital heparin were compared to those who did not receive heparin. Findings at coronary angiography and 30-day clinical outcomes were compared between groups. Propensity-score matching was performed for risk adjustment. We identified a total of 4720 patients. Of these, 1967 patients had TIMI flow data available. Propensity-score matching in the entire cohort yielded 1373 matched pairs. In the matched cohort, there was no observed difference in 30-day mortality (no-heparin 3.5% vs. heparin 3.0%, P = 0.25), MACCE (no-heparin 7% vs. heparin 6.2%, P = 0.44), and major bleeding (no-heparin 1.9% vs. heparin 1.4%, P = 0.64) between groups. Propensity-score analysis amongst those with TIMI data produced 552 matched pairs. The proportion of cases with TIMI 0 or 1 flow in the infarct-related artery (IRA) was lower among those receiving pre-hospital heparin (66% vs. 76%, P < 0.001) compared to those who did not.
In this multicentre, propensity-score matched study, the use of pre-hospital heparin by paramedics was safe and is associated with fewer occluded IRAs in patients presenting with STEMI.
本研究旨在评估护理人员在院前给予肝素是否安全并能改善临床结局。
利用多中心维多利亚心脏结局登记处的数据，并与全州范围的救护车记录相链接，我们确定了2014年1月至2018年12月期间连续接受ST段抬高型心肌梗死直接经皮冠状动脉介入治疗的患者。部分病例可获得血管造影时心肌梗死溶栓（TIMI）血流情况的信息。将接受院前肝素治疗的患者与未接受肝素治疗的患者进行比较。比较两组冠状动脉造影结果和30天临床结局。采用倾向评分匹配法进行风险调整。我们共确定了4720例患者。其中，1967例患者有TIMI血流数据。在整个队列中进行倾向评分匹配产生了1373对匹配病例。在匹配队列中，两组在30天死亡率（未用肝素组3.5% vs. 用肝素组3.0%，P = 0.25）、主要不良心血管和脑血管事件（未用肝素组7% vs. 用肝素组6.2%，P = 0.44）以及大出血（未用肝素组1.9% vs. 用肝素组1.4%，P = 0.64）方面未观察到差异。对有TIMI数据的患者进行倾向评分分析产生了552对匹配病例。与未接受院前肝素治疗的患者相比，接受院前肝素治疗的患者梗死相关动脉（IRA）出现TIMI 0或1级血流的病例比例较低（66% vs. 76%，P < 0.001）。
在这项多中心、倾向评分匹配研究中，护理人员在院前使用肝素是安全的，并且与ST段抬高型心肌梗死患者中IRA闭塞减少有关。
