Prehospital Administration of Unfractionated Heparin in ST-Segment Elevation Myocardial Infarction Is Associated With Improved Long-Term Survival

Autor: Stephan Koch, John Irving, Thomas N. Martin, Ify R. Mordi, Paul Kell, Peter Currie, Christopher McGinley, Stuart Hutcheon
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Emergency Medical Services
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Ambulances
Shock
Cardiogenic
Coronary Artery Disease
030204 cardiovascular system & hematology
Risk Assessment
Drug Administration Schedule
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
ST segment
Myocardial infarction
Vascular Patency
Retrospective Studies
Pharmacology
Heparin
business.industry
Cardiogenic shock
Age Factors
Anticoagulants
Percutaneous coronary intervention
Retrospective cohort study
Odds ratio
Middle Aged
medicine.disease
Treatment Outcome
030104 developmental biology
Scotland
Shock (circulatory)
Cardiology
ST Elevation Myocardial Infarction
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
medicine.drug
Zdroj: Journal of Cardiovascular Pharmacology. 76:159-163
ISSN: 0160-2446
Popis: OBJECTIVE Administration of unfractionated heparin to STEMI patients by the ambulance service is an established practice in Scotland, but the efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention, on infarct artery patency and mortality. METHODS AND RESULTS Consecutive patients (n = 1000) admitted to Ninewells Hospital, Dundee, from 2010 to 2014 for primary percutaneous coronary intervention were allocated to 2 groups: 437 (44%) prehospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin. A trained medical student assessed coronary flow at presentation and collected the data. Mortality status was ascertained at 30 days and 5 years. Cox proportional hazards regression models were generated. The patient groups were similar, although PHH had shorter symptom onset-treatment time (187 vs. 251 minutes, P < 0.001) and less cardiogenic shock (3.9% vs. 8.0%, P = 0.008). Initial coronary flow was not different between the groups. Thirty day mortality in PHH was 2.5% versus 8.3%, P < 0.001. Independent predictors of 30-day mortality were age (odds ratio 1.07, 95% CI 1.04-1.09), cardiogenic shock (5.97, 3.33-10.69), radial access (0.53, 0.28-0.98), and PHH (0.33, 0.17-0.66). Five-year mortality in PHH was 13.0% versus 21.6%, P < 0.001. Significant predictors of long-term mortality were age (1.07, 1.06-1.09), cardiogenic shock (3.40, 2.23-5.17), and PHH (0.68, 0.49-0.96). CONCLUSIONS PHH was associated with reduced short- and long-term mortality after adjusting for important potential confounders.
Databáze: OpenAIRE
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