Effects of pre-transport anticoagulation on coronary blood and cardiac function in patients with STEMI undergoing direct PCI
Objective:To investigate the effect of unfractionated heparin pretreatment on coronary blood flow,cardiac function and in-hospital bleeding events in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Methods:A retrospective cohort study was conducted on continuously selected 125 STEMI patients who underwent direct PCI in Jining First People's Hospital from June 1,2020 to June 30,2022.According to the time point of heparin use,they were divided into pre-transport anticoagulation group(65 cases,who were administered in local hospitals after diagnosis)and con-ventional anticoagulation group(60 cases,who were administered in catheter room).Baseline data,time node of chest pain center and biochemical indicators were collected.The main observation indexes were the coronary blood flow(TIMI blood flow grade)immediately after opening the blood vessel,and the secondary observation indexes were cardiac function(left ventricular ejection fraction,NT-proBNP),myocardial injury markers(cTnI,myoglo-bin,CK,creatine kinase isoenzyme[CK-MB]),bleeding risk and adverse cardiovascular events.Results:There was no significant difference in baseline data,time node of treatment and diseased blood vessels between the two groups(P＞0.05).The level of CK-MB in the conventional anticoagulation group was higher than that in the pre-transport anticoagulation group,and the difference was statistically significant(P＜0.05).The myoglobin level of the conventional anticoagulation group was higher than that of the pre-transport anticoagulation group,and the difference was statistically significant(P＜0.05).The left ventricular ejection fraction(LVEF)in the pre-transport anticoagulation group was higher than that in the conventional anticoagulation group,and the difference was statis-tically significant(P＜0.05).There were 35 cases(58.3％)of TIMI blood flow grade 0-1 in the pre-transport anticoagulation group and 49 cases(78.3％)in the conventional anticoagulation group(P＜0.05).Multivariate bi-nary logistic regression analysis was performed to adjust for confounding factors.Pre-transport anticoagulation was an independent predictor of the incidence of IRA initial blood flow grade 2-3(OR=3.576,95％CI:1.337-9.519,P=0.011).There was no significant difference in the incidence of major adverse cardiovascular events and bleeding events(P＞0.05).Conclusion:Pretreatment with unfractionated heparin before transport can improve IRA patency and cardiac function in STEMI patients without increasing the incidence of adverse cardiovascular e-vents and bleeding events.
acute ST-segment elevation myocardial infarctionpercutaneous coronary interventionheparincoronary blood flowcardiac function
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