Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation myocardial infarction: Does time matter?
Por:
Giralt, T, Ribas, N, Freixa, X, Sabate, M, Caldentey, G, Tizon-Marcos, H, Carrillo, X, Garcia-Picart, J, Lidon, RM, Cardenas, M, Perez-Fernandez, S, Mauri, J and Vaquerizo, B
Publicada:
15 feb 2021
Ahead of Print:
1 ene 2021
Resumen:
Background: Optimal timing of antithrombotic therapy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is unclear. We analyzed the impact of pre-angioplasty administration of unfractionated heparin (UFH) on infarct-related artery (IRA) patency and mortality.
Method: Multicenter prospective observational study of 3520 STEMI patients treated with PPCI from 2016 to 2018. Subjects were divided into four groups according to the elapsed time from heparin administration to PPCI: Group 1: Upon arrival at catheterization laboratory or 6 30 min (n = 800; 22.7%); Group 2: 31 to 60 min (n = 994; 28.2%); Group 3: 61 to 90 min (n 1091; 31%); Group 4: >90 min (n = 635; 18%). IRA patency was defined as thrombolysis in myocardial infarction (TIMI) flow grade 2-3. Multivariate analyses assessed factors associated with IRA patency and both 30-day and 1-year mortality.
Results: UFH administration at STEMI diagnosis was an independent predictor of IRA patency especially when administered more than 60 min before the PPCI (OR 1.43; 95% CI 1.14-1.81), either an independent predictor of 30day (HR 0.63: 95% CI 0.42-0.94) and 1-year (HR 0.57; 95% CI 0.41-0.80) mortality. The effect of UFH on IRA patency was higher when administered earlier from the symptom onset.
Conclusion: UFH administration at STEMI diagnosis improves coronary reperfusion prior to PPCI and this benefit seems associated with superior clinical outcomes. The presented results highlight a time-dependent effectiveness of UFH, since its reported effect is greater the sooner UFH is administered after symptom onset. Published by Elsevier B.V.
Filiaciones:
Giralt, T:
Hosp del Mar, Cardiol Dept, Passeig Maritim Barceloneta 25-29, Barcelona 08003, Spain
IMIM Hosp del Mar Med Res Inst, Heart Dis Biomed Res Grp, Barcelona, Spain
Univ Barcelona, Med Dept, Program Med & Translat Invest, Barcelona, Spain
Ribas, N:
Hosp del Mar, Cardiol Dept, Passeig Maritim Barceloneta 25-29, Barcelona 08003, Spain
IMIM Hosp del Mar Med Res Inst, Heart Dis Biomed Res Grp, Barcelona, Spain
Univ Barcelona, Med Dept, Program Med & Translat Invest, Barcelona, Spain
Univ Autonoma Barcelona, Med Dept, Bellaterra, Spain
Freixa, X:
Univ Barcelona, Med Dept, Program Med & Translat Invest, Barcelona, Spain
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer, Cardiovasc Inst, Barcelona, Spain
Sabate, M:
Univ Barcelona, Med Dept, Program Med & Translat Invest, Barcelona, Spain
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer, Cardiovasc Inst, Barcelona, Spain
Caldentey, G:
Hosp del Mar, Cardiol Dept, Passeig Maritim Barceloneta 25-29, Barcelona 08003, Spain
IMIM Hosp del Mar Med Res Inst, Heart Dis Biomed Res Grp, Barcelona, Spain
Tizon-Marcos, H:
Hosp del Mar, Cardiol Dept, Passeig Maritim Barceloneta 25-29, Barcelona 08003, Spain
IMIM Hosp del Mar Med Res Inst, Heart Dis Biomed Res Grp, Barcelona, Spain
Generalitat Catalunya, AMI Code Registry, Catalan Hlth Serv, Barcelona, Catalonia, Spain
:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Generalitat Catalunya, AMI Code Registry, Catalan Hlth Serv, Barcelona, Catalonia, Spain
Garcia-Picart, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Generalitat Catalunya, AMI Code Registry, Catalan Hlth Serv, Barcelona, Catalonia, Spain
Lidon, RM:
Hosp Valle De Hebron, Cardiol Dept, Barcelona, Spain
Generalitat Catalunya, AMI Code Registry, Catalan Hlth Serv, Barcelona, Catalonia, Spain
Cardenas, M:
Hosp Trueta Girona, Cardiol Dept, Barcelona, Spain
Generalitat Catalunya, AMI Code Registry, Catalan Hlth Serv, Barcelona, Catalonia, Spain
Perez-Fernandez, S:
IMIM Hosp del Mar Med Res Inst, Cardiovasc Epidemiol & Genet Grp EGEC, REGICOR Study Grp, Barcelona, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Generalitat Catalunya, AMI Code Registry, Catalan Hlth Serv, Barcelona, Catalonia, Spain
Vaquerizo, B:
Hosp del Mar, Cardiol Dept, Passeig Maritim Barceloneta 25-29, Barcelona 08003, Spain
IMIM Hosp del Mar Med Res Inst, Heart Dis Biomed Res Grp, Barcelona, Spain
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