PMID- 32991944 OWN - NLM STAT- MEDLINE DCOM- 20210527 LR - 20210527 IS - 1874-1754 (Electronic) IS - 0167-5273 (Linking) VI - 325 DP - 2021 Feb 15 TI - Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation myocardial infarction: Does time matter? PG - 9-15 LID - S0167-5273(20)33839-0 [pii] LID - 10.1016/j.ijcard.2020.09.058 [doi] AB - BACKGROUND: Optimal timing of antithrombotic therapy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is unclear. We analyzed the impact of pre-angioplasty administration of unfractionated heparin (UFH) on infarct-related artery (IRA) patency and mortality. METHOD: Multicenter prospective observational study of 3520 STEMI patients treated with PPCI from 2016 to 2018. Subjects were divided into four groups according to the elapsed time from heparin administration to PPCI: Group 1: Upon arrival at catheterization laboratory or 90 min (n = 635; 18%). IRA patency was defined as thrombolysis in myocardial infarction (TIMI) flow grade 2-3. Multivariate analyses assessed factors associated with IRA patency and both 30-day and 1-year mortality. RESULTS: UFH administration at STEMI diagnosis was an independent predictor of IRA patency especially when administered more than 60 min before the PPCI (OR 1.43; 95% CI 1.14-1.81), either an independent predictor of 30-day (HR 0.63; 95% CI 0.42-0.94) and 1-year (HR 0.57; 95% CI 0.41-0.80) mortality. The effect of UFH on IRA patency was higher when administered earlier from the symptom onset. CONCLUSION: UFH administration at STEMI diagnosis improves coronary reperfusion prior to PPCI and this benefit seems associated with superior clinical outcomes. The presented results highlight a time-dependent effectiveness of UFH, since its reported effect is greater the sooner UFH is administered after symptom onset. CI - Published by Elsevier B.V. FAU - Giralt, Teresa AU - Giralt T AD - Cardiology Department, Hospital del Mar, Passeig Maritim de la Barceloneta, 25-29, 08003 Barcelona, Spain; Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Medicine Department, Program in Medicine and Translational Investigation, Universitat de Barcelona, Barcelona, Spain. Electronic address: 63267@parcdesalutmar.cat. FAU - Ribas, Nuria AU - Ribas N AD - Cardiology Department, Hospital del Mar, Passeig Maritim de la Barceloneta, 25-29, 08003 Barcelona, Spain; Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Medicine Department, Program in Medicine and Translational Investigation, Universitat de Barcelona, Barcelona, Spain; Medicine department, Universitat Autonoma de Barcelona, Bellaterra, Spain. FAU - Freixa, Xavier AU - Freixa X AD - Medicine Department, Program in Medicine and Translational Investigation, Universitat de Barcelona, Barcelona, Spain; Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain. FAU - Sabate, Manel AU - Sabate M AD - Medicine Department, Program in Medicine and Translational Investigation, Universitat de Barcelona, Barcelona, Spain; Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain. FAU - Caldentey, Guillem AU - Caldentey G AD - Cardiology Department, Hospital del Mar, Passeig Maritim de la Barceloneta, 25-29, 08003 Barcelona, Spain; Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. FAU - Tizon-Marcos, Helena AU - Tizon-Marcos H AD - Cardiology Department, Hospital del Mar, Passeig Maritim de la Barceloneta, 25-29, 08003 Barcelona, Spain; Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Catalan Health Service, Generalitat de Catalunya, AMI Code Registry, Barcelona, Catalonia, Spain. FAU - Carrillo, Xavier AU - Carrillo X AD - Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain; Catalan Health Service, Generalitat de Catalunya, AMI Code Registry, Barcelona, Catalonia, Spain. FAU - Garcia-Picart, Joan AU - Garcia-Picart J AD - Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Catalan Health Service, Generalitat de Catalunya, AMI Code Registry, Barcelona, Catalonia, Spain. FAU - Lidon, Rosa Maria AU - Lidon RM AD - Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain; Catalan Health Service, Generalitat de Catalunya, AMI Code Registry, Barcelona, Catalonia, Spain. FAU - Cardenas, Merida AU - Cardenas M AD - Cardiology Department, Hospital Trueta de Girona, Barcelona, Spain; Catalan Health Service, Generalitat de Catalunya, AMI Code Registry, Barcelona, Catalonia, Spain. FAU - Perez-Fernandez, Silvia AU - Perez-Fernandez S AD - IMIM (Hospital del Mar Medical Research Institute), Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain. FAU - Mauri, Josepa AU - Mauri J AD - Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain; Catalan Health Service, Generalitat de Catalunya, AMI Code Registry, Barcelona, Catalonia, Spain. FAU - Vaquerizo, Beatriz AU - Vaquerizo B AD - Cardiology Department, Hospital del Mar, Passeig Maritim de la Barceloneta, 25-29, 08003 Barcelona, Spain; Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20200928 PL - Netherlands TA - Int J Cardiol JT - International journal of cardiology JID - 8200291 RN - 0 (Fibrinolytic Agents) RN - 9005-49-6 (Heparin) SB - IM MH - Angioplasty MH - Fibrinolytic Agents/pharmacology MH - Heparin/pharmacology MH - Humans MH - *Myocardial Infarction/diagnosis/drug therapy/surgery MH - Myocardial Reperfusion MH - *Percutaneous Coronary Intervention MH - *ST Elevation Myocardial Infarction/diagnostic imaging/drug therapy MH - Treatment Outcome MH - Vascular Patency OTO - NOTNLM OT - Anticoagulation OT - Coronary reperfusion OT - IRA patency OT - PPCI OT - STEMI OT - Unfractionated heparin COIS- Declaration of Competing Interest None. EDAT- 2020/09/30 06:00 MHDA- 2021/05/28 06:00 CRDT- 2020/09/29 20:08 PHST- 2020/06/14 00:00 [received] PHST- 2020/08/17 00:00 [revised] PHST- 2020/09/20 00:00 [accepted] PHST- 2020/09/30 06:00 [pubmed] PHST- 2021/05/28 06:00 [medline] PHST- 2020/09/29 20:08 [entrez] AID - S0167-5273(20)33839-0 [pii] AID - 10.1016/j.ijcard.2020.09.058 [doi] PST - ppublish SO - Int J Cardiol. 2021 Feb 15;325:9-15. doi: 10.1016/j.ijcard.2020.09.058. Epub 2020 Sep 28.