The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Abstract

INTRODUCTIONCoronary artery disease (CAD) is the main cause of death, morbidity and disability in the world and their prevalence is highly increasing in developing countries. In CAD patients, acute coronary syndrome (ACS) has the most importance because of the high possibility of unpleasant cardiovascular events during follow-up was more in these patients. In 2008, 7.3 million (12.8%) out of 57 million deaths was because of myocardial infraction. In the United States, almost 650 thousand patients get new acute myocardial infraction (AMI) per year. The rate of early death (30 days) with AMI is about 30% and more than half of these cases occur before reaching to the hospital. 1,2During the last two decades, the rate of the death of coronary disease is decreasing in developed countries, whereas it is increasing in developing countries which is mostly because of long lifetime, urbanization and lifestyle changes. In the United States, the adjusted rate of death based age due to coronary disease has been declined to two third in four last decades which is the reflection of better diagnosis and reduce risk factors and also improvement of faster ABSTRACT Background: Primary PCI (PPCI) is the main reperfusion treatment for STsegment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI. Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02±13.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups. Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups. Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.

The effect of heparin after primary percutaneous coronary intervention on short-term clinical outcomes in patients with ST-segment elevation myocardial infarction

“…12 Conversely, Zamani and colleagues demonstrated that there were no differences between TIMI scores in two groups. 9 Four major bleeding occurred in the current study, 3 (1.5%) in the heparin group and 1 (0.5%) in the control group, which is not significantly higher than previous studies that heparin be prescribed with PCI. [10][11][12][13][14] Of these 4 patients, all experienced profuse bleeding in the tracheostomy site, and 2 patients required a blood transfusion after PCI.…”

“…Zamani and colleagues reported that in case group compared to control group the rate of hematoma was higher but not significant. 9 Plus, Bonello's survey in USA, with a similar design as ours, found that the incidence rate of Hematoma in heparin group was more than control group. 16 The findings of this study showed that the control group had more 30-day death compared to intervention group but difference was not statistically significant (1.5% vs. 0%).…”

“…In line with findings, Zamani's survey in Iran, Ardabil, reported that EF has improved in patients who received heparin comparing control group. 9 Zijlstra et al reported that patients who received pre hospital heparin significantly had higher EF. 10 Verheugt et al observed that early therapy with heparin resulted in full coronary reperfusion in a significant number of MI patients.…”

“…17 Furthermore, Zamani and assistants reported that the heparin group had more 30day mortality than control group but not meaningful. 9 Jovin et al demonstrated that the heparin group had more death than control group, significantly. 18 Zijlstra et al showed that heparin group comparing control group had lower 30-day death rate.…”