Author + information
- Sofia Karlsson,
- Moman A. Mohammad,
- Pontus Andell,
- Bo Lagerqvist,
- Stefan James,
- Goran Olivecrona,
- Ole Frobert and
- David Erlinge
Background: ST elevation myocardial infarction (STEMI) is most commonly caused by the rupture of a thin cap fibro-atheroma with subsequent thrombus formation and vessel occlusion. Percutaneous coronary intervention (PCI) with additive potent antithrombotic medication is the recommended therapy in STEMI. However, the optimum combination and timing of antithrombotic medications is unknown. Prehospital administration of heparin is common in local practice, without conclusive supporting data. We aimed to study the effect of heparin pretreatment on Trombolysis In Myocardial Infarction (TIMI) grade flow and thrombus burden before primary PCI in patients with STEMI.
Methods: Angiographically assessed thrombus burden (grade 0-5) and TIMI grade flow (0-3) before primary PCI were reported in 7244 patients with STEMI, included in the Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) study (2010-2013). Baseline characteristics were compared between the groups and multivariable logistic regressions were performed to evaluate the effect of heparin pretreatment before PCI. The primary endpoints were TIMI 0 (no perfusion) before PCI and “definite thrombus” (thrombus grade 2-5) before PCI.
Results: Heparin pretreatment was administered in 2941 (41%) patients. Patients in the heparin and no-heparin groups did not differ in age, gender or previous cardiovascular disease. The heparin group more often received dual antiplatelet therapy (DAPT) and glycoproteinllb/llla-inhibitors prior to PCI, whereas the no-heparin group more often received low molecular weight heparin. After adjustments in multivariable logistic regression, heparin pretreatment was associated with significantly lower occurrence of the primary endpoints of TIMI 0 flow (OR: 0.641 95% CI 0.573-0.718) and “definite thrombus” (OR 0.822 95% CI 0.737-0.917).
Conclusions: In this large scale observational study of patients with STEMI, heparin pretreatment was associated with a reduced risk of no perfusion (TIMI 0) and “definite thrombus” before PCI.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Developments in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1194-141
- 2017 American College of Cardiology Foundation