Pretreatment With Unfractionated Heparin in ST-Elevation Myocardial Infarction—a Propensity Score Matching Analysis.

IF 6.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI:10.3238/arztebl.m2024.0212

Sascha Macherey-Meyer, Sebastian Heyne, Max Maria Meertens, Karl Finke, Victor Mauri, Ingo Ahrens, Frank Michael Baer, Frank Eberhardt, Marc Horlitz, Jan-Malte Sinning, Axel Meissner, Benjamin Rosswinkel, Stephan Baldus, Christoph Adler, Samuel Lee

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Abstract

Background: Patients with ST-segment elevation myocardial infarction (STEMI) are often pretreated with unfractionated heparin (UFH) before a primary percutaneous coronary intervention (PPCI). UFH pretreatment is intended to lessen the thrombotic burden, but there have been conflicting study findings on its safety and efficacy. We assessed the risks and benefits of UFH pretreatment with a retrospective analysis of registry data from the STEMI network of a German metropolitan region.

Methods: Data from patients with STEMI referred for PPCI from 2005 to 2020 were evaluated with an adjusted outcome analysis, including propensity score matching (PSM). The endpoints included the patency of the infarct-related artery (IRA) after PPCI, in-hospital mortality, access-site bleeding, and the peak creatine kinase (CK) level.

Results: We assessed data from 4632 patients with STEMI: 4420 (95.4%) were pretreated with UFH, and 212 (4.6%) were not. After PSM of 511 vs. 187 patients, the adjusted odds ratios for the various endpoints were (pretreatment vs. no pretreatment, with 95% confidence intervals): for impaired flow of the IRA, 1.01 [0.59; 1.74]; for in-hospital mortality, 1.46 [0.88; 2.42]; and for access-site bleeding, 0.59 [0.14; 2.46]. The peak creatine kinase levels were similar in the two groups (median, 1248.0 vs. 1376.5 U/L, estimated difference -134 [-611; 341]).

Conclusion: UFH pretreatment was less frequently performed in STEMI patients who had undergone cardiopulmonary resuscitation. UFH pretreatment was not associated with increased access site bleeding, nor was it found to have significantly higher efficacy with respect to the relevant endpoints. The risks and benefits of UFH pretreatment should be weighed individually in each case, as evidence from high-quality clinical trials is lacking. Data from the existing literature suggest that no pretreatment is an option to be considered, as are certain alternative antithrombotic strategies.

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ST段抬高型心肌梗死患者使用非减量肝素预处理--倾向评分匹配分析。

背景：ST段抬高型心肌梗死（STEMI）患者在接受一级经皮冠状动脉介入治疗（PPCI）前通常会使用非分叶肝素（UFH）进行预处理。UFH 预处理的目的是减轻血栓形成的负担，但有关其安全性和有效性的研究结果却相互矛盾。我们通过对德国大都会地区 STEMI 网络的登记数据进行回顾性分析，评估了 UFH 预处理的风险和益处：方法：我们对 2005 年至 2020 年转诊进行 PPCI 的 STEMI 患者数据进行了调整结果分析评估，包括倾向评分匹配（PSM）。结果：我们评估了 4632 名 STEMI 患者的数据，其中包括倾向评分匹配（PSM）患者，他们在 PPCI 术后的梗死相关动脉（IRA）通畅率、院内死亡率、入路部位出血量和肌酸激酶（CK）峰值水平：我们评估了4632名STEMI患者的数据：4420名患者（95.4%）接受了UFH预处理，212名患者（4.6%）未接受预处理。对 511 名患者和 187 名患者进行 PSM 后，各种终点的调整几率比为（预处理与不预处理，95% 置信区间）：IRA 血流受损为 1.01 [0.59; 1.74]；院内死亡率为 1.46 [0.88; 2.42]；入路部位出血为 0.59 [0.14; 2.46]。两组患者的肌酸激酶峰值水平相似（中位数为1248.0 U/L对1376.5 U/L，估计差异为-134 [-611; 341]）：结论：接受过心肺复苏的 STEMI 患者较少接受 UFH 预处理。UFH预处理与入路部位出血增加无关，在相关终点方面的疗效也没有明显提高。由于缺乏高质量临床试验的证据，UFH 预处理的风险和益处应视具体情况而定。现有文献数据表明，与某些替代抗血栓策略一样，不进行预处理也是一种值得考虑的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Deutsches Arzteblatt international 医学-医学：内科

CiteScore

4.10

自引率

5.20%

发文量

306

审稿时长

4-8 weeks

期刊介绍： Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.