Luca Franchin, Federico Angriman, Andrea Pezzato, Luca Siega Vignut, Enrico Fabris, Gianfranco Sinagra, Arnoud W J van 't Hof, Massimo Imazio
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Random-effect meta-analysis was performed comparing clinical outcomes between the two groups.</p><p><strong>Results: </strong>11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56-0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48-0.94). 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引用次数: 0
摘要
目的：比较肝素预处理与术中给药对st段抬高型心肌梗死患者预后的影响。背景：STEMI患者肝素给药的最佳时机缺乏相关数据。方法：系统检索1980 - 2024年间肝素预处理与术中给药治疗STEMI的疗效和安全性比较研究文献。采用随机效应meta分析比较两组临床结果。结果：纳入11项观察性研究和4项临床试验，共纳入72249例患者。患者要么在诊断时接受UFH，要么在pPCI期间接受UFH。预处理方法显示30天死亡率显著降低(OR = 0.68；95% CI 0.56-0.84)以及更长时间的随访(平均随访时间14.4个月；or = 0.67；95% ci 0.48-0.94)。此外，UFH预处理增加了首次冠状动脉造影时梗死相关动脉通畅率（IRA）（定义为TIMI 2-3） (OR = 1.54；95% CI 1.37-1.74)，未显示大出血增加（OR 0.96, 95% CI 0.74-1.24）。结论：STEMI诊断时的肝素预处理策略与梗死相关动脉通畅度增加和死亡风险降低相关，且无出血并发症的安全性问题。
Heparin pretreatment in patients with ST-segment elevation myocardial infarction: A meta-analysis.
Objectives: To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction.
Background: There is a paucity of data regarding the best timing for heparin administration in STEMI.
Methods: We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups.
Results: 11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56-0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48-0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2-3) at first coronary angiography (OR = 1.54; 95 % CI 1.37-1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74-1.24).
Conclusion: A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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