Scholz Phillip, Friede Tim, Scholz Karl Heinrich, Grabmaier Ulrich, Meyer Thomas, Seidler Tim
Department of Cardiology, Heart Center, University Medical Center Göttingen, Goettingen, Germany.
Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, and DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Goettingen, Germany.
Clin Res Cardiol. 2024 Aug 1. doi: 10.1007/s00392-024-02499-y.
Pre-hospital heparin administration has been reported to improve prognosis in patients with out-of-hospital cardiac arrest (OHCA). This beneficial effect may be limited to the subgroup of ST-segment elevation myocardial infarction (STEMI) patients.
To assess the impact of pre-hospital heparin loading on TIMI (Thrombolysis in Myocardial Infarction) flow grade and mortality in STEMI patients with OHCA, we analyzed data from 2,566 consecutive patients from two hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) trial.
In 394 participants with OHCA, 272 (69%) received heparin from the emergency medical service (EMS). Collapse witnessed by EMS (odds ratio (OR) = 3.53, 95%-confidence interval (CI) = 1.54-8.09; p = 0.003) and pre-hospital ECG recording (OR = 3.32, 95% CI = 1.06-10.35; p = 0.039) were identified as parameters significantly associated with pre-hospital heparin use. In univariate analysis, in-hospital mortality was lower in the group receiving heparin in the pre-hospital setting (26.8% vs. 42.6%, p = 0.002). However, in a regression model, pre-hospital heparin use was no longer a significant predictor of mortality (OR = 0.992; p = 0.981). Patency of the infarct artery prior to coronary revascularization, as measured by TIMI flow grade, was not associated with pre-hospital administration of heparin in OHCA patients (OR = 0.840; p = 0.724).
In STEMI patients with OHCA, pre-hospital use of heparin is neither associated with improved early patency of the infarct artery nor with a better prognosis. Our results do not support the assumption of a positive effect of heparin administration in the pre-hospital treatment phase in STEMI patients with OHCA.
ClinicalTrials.gov: NCT00794001.
据报道，院外心脏骤停（OHCA）患者在院前使用肝素可改善预后。这种有益效果可能仅限于ST段抬高型心肌梗死（STEMI）患者亚组。
为评估院前负荷剂量肝素对OHCA的STEMI患者心肌梗死溶栓（TIMI）血流分级及死亡率的影响，我们分析了来自两家医院的2566例连续患者的数据，这些患者参与了前瞻性ST段抬高型心肌梗死反馈干预与治疗时间（FITT-STEMI）试验。
在394例OHCA参与者中，272例（69%）在紧急医疗服务（EMS）时接受了肝素治疗。EMS目击的心搏骤停（优势比（OR）=3.53，95%置信区间（CI）=1.54 - 8.09；p = 0.003）和院前心电图记录（OR = 3.32，95% CI = 1.06 - 10.35；p = 0.039）被确定为与院前使用肝素显著相关的参数。在单因素分析中，院前接受肝素治疗组的院内死亡率较低（26.8%对42.6%，p = 0.002）。然而，在回归模型中，院前使用肝素不再是死亡率的显著预测因素（OR = 0.992；p = 0.981）。通过TIMI血流分级测量，冠状动脉血运重建前梗死相关动脉的通畅情况与OHCA患者院前使用肝素无关（OR = 0.840；p = 0.724）。
在OHCA的STEMI患者中，院前使用肝素既与梗死相关动脉早期通畅情况改善无关，也与更好的预后无关。我们的结果不支持在OHCA的STEMI患者院前治疗阶段使用肝素具有积极作用这一假设。
ClinicalTrials.gov：NCT007794001。
