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Evaluation of Early Heparin Use Prior to Catheterization in STEMI: A Real-World Cohort Study
Session:
Sessão de Posters 43 - Da disseção da artéria coronária às decisões antitrombóticas e de reperfusão nas síndromes coronárias agudas
Speaker:
Raquel Fernandes da Silva
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Raquel Fernandes da Silva; Marta Paralta de Figueiredo; Rita Caldeira da Rocha; Gustavo Sá Mendes; Diogo Brás; David Neves; Ângela Bento; Renato Fernandes; Manuel Trinca; Lino Patrício
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Background:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> In ST-elevation myocardial infarction (STEMI), achieving early thrombus control may help preserve coronary perfusion and limit myocardial damage. Although intraprocedural unfractionated heparin (UFH) is standard during primary PCI, the benefit of giving a pre-hemodynamic dose (pre-HD, 5000 U) earlier in the pre-hospital or emergency setting remains unclear.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Objectives:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> To evaluate whether pre-HD heparin is associated with reduced in-hospital all-cause mortality, 30-day major adverse cardiovascular events (MACE), and increased bleeding, and to determine whether its association with in-hospital mortality is independent of clinical confounders.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> We retrospectively analysed 192 STEMI patients treated with primary PCI between 2023 and 2024. Patients were divided according to UFH strategy: intraprocedural UFH only or additional pre-HD UFH (5000 U). Primary endpoints were in-hospital mortality and bleeding; secondary endpoint was 30-day MACE. Variables with p<0.10 in univariable analysis were entered into a multivariable logistic regression to determine whether pre-HD UFH was independently associated with mortality.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Baseline characteristics were similar between groups: mean age 64.7±12.9 years, 73.4% male, hypertension 62.0%, diabetes 32.3%, Killip ≥ II 13.5%, and creatinine 1.00±0.53 mg/dL. Pre-HD UFH was given in 48% of patients. In-hospital mortality was lower in the pre-HD group (6.7% vs 20.6%, p=0.004). Bleeding occurred in 9.9%, with no significant difference between groups (p=0.140). MACE at 30 days was 18.9%, with a trend towards fewer events in the pre-HD group (13.3% vs 24.2%, p=0.059). No differences were observed in symptom-to-contact, contact-to-ECG or contact-to-cath lab delays. In multivariable analysis, pre-HD UFH was independently associated with lower in-hospital mortality (OR 0.25; p=0.035).</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Early administration of UFH (5000 U) before cath lab arrival was independently associated with reduced in-hospital mortality in STEMI, without increasing bleeding, and with a favorable trend in 30-day MACE. These findings support the potential benefit of initiating anticoagulation earlier in STEMI management.</span></span></span></p>
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