Objectives: To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction. Background: There is a paucity of data regarding the best timing for heparin administration in STEMI. Methods: We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. Results: 11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56–0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48–0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2–3) at first coronary angiography (OR = 1.54; 95 % CI 1.37–1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74–1.24). Conclusion: A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.
Heparin pretreatment in patients with ST-segment elevation myocardial infarction: A meta-analysis
Angriman, Federico;Pezzato, Andrea;Vignut, Luca Siega;Fabris, Enrico;Sinagra, Gianfranco;
2025-01-01
Abstract
Objectives: To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction. Background: There is a paucity of data regarding the best timing for heparin administration in STEMI. Methods: We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. Results: 11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56–0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48–0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2–3) at first coronary angiography (OR = 1.54; 95 % CI 1.37–1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74–1.24). Conclusion: A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.Pubblicazioni consigliate
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