Pre-hospital administration of unfractionated heparin in STEMI is associated with improved long term survival

C. McGinley; I. R. Mordi; P. Kelly; P. Currie; S. Hutcheon; S. Koch; T. Martin; J. Irving

doi:10.1097/FJC.0000000000000865

Pre-hospital administration of unfractionated heparin in STEMI is associated with improved long term survival

C. McGinley, I. R. Mordi, P. Kelly, P. Currie, S. Hutcheon, S. Koch, T. Martin, J. Irving (Lead / Corresponding author)

Molecular and Clinical Medicine

Research output: Contribution to journal › Article

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Abstract

Objective: Administration of unfractionated heparin to STEMI patients by the ambulance service is established practice in Scotland, but efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention (PPCI), on infarct artery patency and mortality.

Methods and results: Consecutive patients (n=1,000) admitted to Ninewells Hospital, Dundee, from 2010-2014 for PPCI were allocated to two groups: 437 (44%) pre-hospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin (IHH). 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 min vs. 251 min, 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% vs. 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 pre-hospital heparin (0.33, 0.17-0.66). Five year mortality in PHH was 13.0% vs. 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 pre-hospital heparin (0.68, 0.49-0.96).

Conclusions: Pre-hospital heparin was associated with reduced short and long-term mortality after adjusting for important potential confounders.

Original language	English
Journal	Journal of Cardiovascular Pharmacology
DOIs	https://doi.org/10.1097/FJC.0000000000000865
Publication status	E-pub ahead of print - 22 Jun 2020

Keywords

Heparin
STEMI
pre-hospital treatment
Primary PCI

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McGinley, C., Mordi, I. R., Kelly, P., Currie, P., Hutcheon, S., Koch, S., Martin, T., & Irving, J. (2020). Pre-hospital administration of unfractionated heparin in STEMI is associated with improved long term survival. Journal of Cardiovascular Pharmacology. https://doi.org/10.1097/FJC.0000000000000865

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title = "Pre-hospital administration of unfractionated heparin in STEMI is associated with improved long term survival",

abstract = "Objective: Administration of unfractionated heparin to STEMI patients by the ambulance service is established practice in Scotland, but efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention (PPCI), on infarct artery patency and mortality.Methods and results: Consecutive patients (n=1,000) admitted to Ninewells Hospital, Dundee, from 2010-2014 for PPCI were allocated to two groups: 437 (44%) pre-hospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin (IHH). 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 min vs. 251 min, 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% vs. 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 pre-hospital heparin (0.33, 0.17-0.66). Five year mortality in PHH was 13.0% vs. 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 pre-hospital heparin (0.68, 0.49-0.96).Conclusions: Pre-hospital heparin was associated with reduced short and long-term mortality after adjusting for important potential confounders.",

keywords = "Heparin, STEMI, pre-hospital treatment, Primary PCI",

author = "C. McGinley and Mordi, {I. R.} and P. Kelly and P. Currie and S. Hutcheon and S. Koch and T. Martin and J. Irving",

year = "2020",

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language = "English",

journal = "Journal of Cardiovascular Pharmacology",

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TY - JOUR

T1 - Pre-hospital administration of unfractionated heparin in STEMI is associated with improved long term survival

AU - McGinley, C.

AU - Mordi, I. R.

AU - Kelly, P.

AU - Currie, P.

AU - Hutcheon, S.

AU - Koch, S.

AU - Martin, T.

AU - Irving, J.

PY - 2020/6/22

Y1 - 2020/6/22

N2 - Objective: Administration of unfractionated heparin to STEMI patients by the ambulance service is established practice in Scotland, but efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention (PPCI), on infarct artery patency and mortality.Methods and results: Consecutive patients (n=1,000) admitted to Ninewells Hospital, Dundee, from 2010-2014 for PPCI were allocated to two groups: 437 (44%) pre-hospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin (IHH). 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 min vs. 251 min, 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% vs. 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 pre-hospital heparin (0.33, 0.17-0.66). Five year mortality in PHH was 13.0% vs. 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 pre-hospital heparin (0.68, 0.49-0.96).Conclusions: Pre-hospital heparin was associated with reduced short and long-term mortality after adjusting for important potential confounders.

AB - Objective: Administration of unfractionated heparin to STEMI patients by the ambulance service is established practice in Scotland, but efficacy is unknown. We studied the effects of unfractionated heparin in STEMI patients treated by primary percutaneous coronary intervention (PPCI), on infarct artery patency and mortality.Methods and results: Consecutive patients (n=1,000) admitted to Ninewells Hospital, Dundee, from 2010-2014 for PPCI were allocated to two groups: 437 (44%) pre-hospital heparin (PHH) administered by paramedics, and 563 (56%) in-hospital heparin (IHH). 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 min vs. 251 min, 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% vs. 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 pre-hospital heparin (0.33, 0.17-0.66). Five year mortality in PHH was 13.0% vs. 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 pre-hospital heparin (0.68, 0.49-0.96).Conclusions: Pre-hospital heparin was associated with reduced short and long-term mortality after adjusting for important potential confounders.

KW - Heparin

KW - STEMI

KW - pre-hospital treatment

KW - Primary PCI

U2 - 10.1097/FJC.0000000000000865

DO - 10.1097/FJC.0000000000000865

M3 - Article

C2 - 32590402

JO - Journal of Cardiovascular Pharmacology

JF - Journal of Cardiovascular Pharmacology

SN - 0160-2446

ER -