title: Time-dependent effects of unfractionated heparin in patients with ST-elevation myocardial infarction transferred for primary angioplasty.
abstract: OBJECTIVE
  Initial thrombolysis in myocardial infarction (TIMI) flow and mortality are related in ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty (PPCI). It is unclear whether early adjunctive treatment with unfractionated heparin (UFH) is beneficial for coronary patency. We investigated the effect of UFH administered before transfer versus in the catheterization laboratory (CathLab) on initial patency of the infarct related artery (IRA) in transferred STEMI patients treated with PPCI.
  
  
  RESULTS
  Consecutive STEMI patients (n=1326, February 2007-December 2013) were allocated in two groups relative to UFH administration: pre-transfer group - administration by ambulance crew or physician-in-charge at the non-PPCI centre, 758 patients (57%); post-transfer group - administration in the CathLab, 568 patients (43%). The time range between symptom onset (SO) and UFH administration (SO-UFH) was assessed and the 1-year mortality prediction was analysed by logistic regression. Initial IRA TIMI 2-3 flow was 30.3% in pre-transfer group vs. 21.2% in post-transfer group (p<0.001). A time-dependent association was found between SO-UFH and initial TIMI 2-3 in pre- vs. post-transfer groups [<120 min: 33.2% vs. 18%, p<0.001; 120-240 min: 29.2% vs. 22.8%, p=0.18; >240 min: 25% vs. 28%, p=0.57]. No differences in major bleeding were found between groups. UFH administration before transfer remained an independent predictor for initial TIMI 2-3 flow (OR 1.60 CI 95% 1.22-2.11, p=0.01) and for 1-year mortality (OR 0.51 CI 95% 0.29-0.91, p=0.02).
  
  
  CONCLUSIONS
  Early UFH administration in STEMI patients transferred for PPCI results in higher IRA initial patency in a time-dependent manner and improves clinical outcomes.
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Electronic address: teresagiralt@gmail.com.
authors.forename: Teresa
authors.initials: T
authors.lastname: Giralt
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Carrillo
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Rodriguez-Leor
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Fernandez-Nofrerias
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Rueda
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Serra-Flores
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Viguer
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Josepa
authors.initials: J
authors.lastname: Mauri
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Curos
authors.affiliation: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D010360:Patient Transfer / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects / Q000502:physiology
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Heparin; Primary angioplasty; STEMI