Sundermeyer Jonas, Schock Alina, Kellner Caroline, Haller Paul M, Lehmacher Jonas, Thießen Niklas, Toprak Betül, Scharlemann Lea, Twerenbold Raphael, Sörensen Nils Arne, Clemmensen Peter, Neumann Johannes T
Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Clin Res Cardiol. 2025 Jun;114(6):738-748. doi: 10.1007/s00392-024-02507-1. Epub 2024 Aug 5.
Evidence supporting pre-hospital heparin administration in patients with suspected non-ST segment elevation acute coronary syndrome (NSTE-ACS) is lacking. We aim to evaluate if pre-hospital heparin administration by emergency medical service improves clinical outcome in patients with suspected NSTE-ACS.
Patients with suspected myocardial infarction (MI) presenting to the emergency department were prospectively enrolled from 2013 to 2021, excluding those with ST segment elevation MI. Patients with and without prehospital heparin administration were compared using propensity score matching. To assess the association between pre-hospital heparin loading, 30-day and 1-year mortality, Kaplan-Meier estimations and Cox regression models were used.
Among 1,234 patients, median age was 69 years, 755 (61.2%) were male, 867 (70.5%) with known hypertension, 177 (14.4%) had diabetes, 280 (23.1%) were current smokers, and 444 (36.0%) had a history of CAD. Compared to patients without pre-hospital heparin administration, heparin pre-treated patients were more often active smokers (26.5% vs. 20.8%). After propensity matching, 475 patients with vs. without pre-hospital heparin administration were compared, with no significant difference in 30-day mortality (no-heparin 1.3% vs. heparin 0.4%) and 1-year mortality (no-heparin 7.2% vs. heparin 5.5%, adjusted HR 0.98, CI 0.95-1.01, p = 0.22). Bleeding events occurred at a low frequency (< 2%) and did not differ between groups.
In this study, pre-hospital heparin administration was not associated with improved clinical outcome in patients with suspected NSTE-ACS. These findings question pre-hospital heparin therapy in this patient population and might potentially warrant a more restricted utilization pending in-hospital risk assessment.
缺乏支持对疑似非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者进行院前肝素治疗的证据。我们旨在评估紧急医疗服务机构进行院前肝素治疗是否能改善疑似NSTE-ACS患者的临床结局。
2013年至2021年，前瞻性纳入到急诊科就诊的疑似心肌梗死（MI）患者，排除ST段抬高型MI患者。采用倾向评分匹配法比较接受和未接受院前肝素治疗的患者。为评估院前肝素负荷量与30天和1年死亡率之间的关联，使用了Kaplan-Meier估计法和Cox回归模型。
在1234例患者中，中位年龄为69岁，755例（61.2%）为男性，867例（70.5%）有高血压病史，177例（14.4%）患有糖尿病，280例（23.1%）为当前吸烟者，444例（36.0%）有CAD病史。与未接受院前肝素治疗的患者相比，接受肝素预处理的患者更常为当前吸烟者（26.5%对20.8%）。倾向匹配后，比较了475例接受和未接受院前肝素治疗的患者，30天死亡率（未用肝素组1.3%对肝素组0.4%）和1年死亡率（未用肝素组7.2%对肝素组5.5%，调整后HR 0.98，CI 0.95-1.01，p = 0.22）无显著差异。出血事件发生率较低（<2%），且组间无差异。
在本研究中，院前肝素治疗与疑似NSTE-ACS患者临床结局的改善无关。这些发现对该患者群体的院前肝素治疗提出了质疑，可能需要在进行院内风险评估之前更严格地限制其使用。
