Effect Of Unfractionated Heparin Pretreatment On Myocardial Perfusion In Patiens With STEMI Undergoing PPCI

Objective:To investigate the effect of administration unfractionated heparin(UFH)prior to primary percutaneous coronary intervention(PPCI)on myocardial perfusion in patients with ST-elevation myocardial infarction(STEMI).Methods:A total of 254 patients with STEMI undergoing PPCI from October 2017 to December 2018 in 900TH Hospital of Joint Logistics Support Force were enrolled consecutively in this prospective cohort study.Patients were assigned into two groups relative to UFH administration:the early treatment group(patients received UFH at emergency resuscitation room and the median time of UFH administration to balloon was 54.0(49.0,59.0)minutes,n=131),the routine treatment group(patients received UFH at CathLab and the median time of UFH administration to balloon was 40.9(38.0,44.0),n=123)minutes.The primary outcomes is myocardial perfusion.The secondary outcomes is the incidence of major adverse cardiovascular events(MACE)during hospitalization.Results:The age of enrolled patients was(61.4 ± 11.3)years old,and 223 cases(87.8%)of them were male.The median time of symptom-onset to balloon was 5.5(4.0,7.9)hours.There were significancantly difference in The Thrombolysis In Myocardial Infarction(TIMI)0～1 flow in the infarct related artery(IRA)at initial angiogram(58.0%and 92.7%),cTFC immediately after PPCI was((21.6(14.7,26.0)frames and 37.3(23.5,49.7)frames,the patency of IRA after PPCI reach to TIMI 3 was 90.8%and 78.9%,incidence of no reflow phenomenon after PPCI was 12.9%and 30.9%,ST-segment resolution at 2 hours after procedure was 84.7%and 74.0%between the 2 groups(P<0.01 or 0.05).According to the multivariate logistic regression models,early UFH pretreatment was associated with lower incidence of NRP(OR=0.932,95%CI 0.887～0.980,P=0.006),acted as a protecting factor.However,The time of symptom-onset to balloon(OR=1.107,95%CI 1.008～1.216,P=0.034)and TIMI 0 or 1 flow in IRA at initial angiogram(OR=5.902,95%CI 1.232～28.266)promoting the occurrence of NRP.Fatal bleeding events is similar between groups(P>0.05).Conclusions:The results of this study demonstrate that Early unfractionated heparin administration is safe and could significantly improve the myocardial perfudion after PPCI in STEMI patients.