Abstract：
BACKGROUND: Pre-hospital heparin administration has been reported to improve prognosis in patients with out-of-hospital cardiac arrest (OHCA). This beneficial effect may be limited to the subgroup of ST-segment elevation myocardial infarction (STEMI) patients.
METHODS: To assess the impact of pre-hospital heparin loading on TIMI (Thrombolysis in Myocardial Infarction) flow grade and mortality in STEMI patients with OHCA, we analyzed data from 2,566 consecutive patients from two hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) trial.
RESULTS: In 394 participants with OHCA, 272 (69%) received heparin from the emergency medical service (EMS). Collapse witnessed by EMS (odds ratio (OR) = 3.53, 95%-confidence interval (CI) = 1.54-8.09; p = 0.003) and pre-hospital ECG recording (OR = 3.32, 95% CI = 1.06-10.35; p = 0.039) were identified as parameters significantly associated with pre-hospital heparin use. In univariate analysis, in-hospital mortality was lower in the group receiving heparin in the pre-hospital setting (26.8% vs. 42.6%, p = 0.002). However, in a regression model, pre-hospital heparin use was no longer a significant predictor of mortality (OR = 0.992; p = 0.981). Patency of the infarct artery prior to coronary revascularization, as measured by TIMI flow grade, was not associated with pre-hospital administration of heparin in OHCA patients (OR = 0.840; p = 0.724).
CONCLUSIONS: In STEMI patients with OHCA, pre-hospital use of heparin is neither associated with improved early patency of the infarct artery nor with a better prognosis. Our results do not support the assumption of a positive effect of heparin administration in the pre-hospital treatment phase in STEMI patients with OHCA.
BACKGROUND: ClinicalTrials.gov: NCT00794001.
METHODS: To assess the impact of pre-hospital heparin loading on TIMI (Thrombolysis in Myocardial Infarction) flow grade and mortality in STEMI patients with OHCA, we analyzed data from 2,566 consecutive patients from two hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) trial.
RESULTS: In 394 participants with OHCA, 272 (69%) received heparin from the emergency medical service (EMS). Collapse witnessed by EMS (odds ratio (OR) = 3.53, 95%-confidence interval (CI) = 1.54-8.09; p = 0.003) and pre-hospital ECG recording (OR = 3.32, 95% CI = 1.06-10.35; p = 0.039) were identified as parameters significantly associated with pre-hospital heparin use. In univariate analysis, in-hospital mortality was lower in the group receiving heparin in the pre-hospital setting (26.8% vs. 42.6%, p = 0.002). However, in a regression model, pre-hospital heparin use was no longer a significant predictor of mortality (OR = 0.992; p = 0.981). Patency of the infarct artery prior to coronary revascularization, as measured by TIMI flow grade, was not associated with pre-hospital administration of heparin in OHCA patients (OR = 0.840; p = 0.724).
CONCLUSIONS: In STEMI patients with OHCA, pre-hospital use of heparin is neither associated with improved early patency of the infarct artery nor with a better prognosis. Our results do not support the assumption of a positive effect of heparin administration in the pre-hospital treatment phase in STEMI patients with OHCA.
BACKGROUND: ClinicalTrials.gov: NCT00794001.
摘要：
背景：据报道，院前肝素可以改善院外心脏骤停（OHCA）患者的预后。这种有益效果可能仅限于ST段抬高型心肌梗死（STEMI）患者的亚组。
方法：评估院前肝素负荷对STEMI合并OHCA患者TIMI（心肌梗死溶栓）血流分级和死亡率的影响，我们分析了来自两家医院的2,566名连续患者的数据,这些患者参与了前瞻性反馈干预和ST段抬高型心肌梗死(FITT-STEMI)试验.
结果：在394名OHCA参与者中，272人（69％）从紧急医疗服务（EMS）接受了肝素。EMS（比值比（OR）=3.53，95％置信区间（CI）=1.54-8.09；p=0.003）和院前心电图记录（OR=3.32，95％CI=1.06-10.35；p=0.039）见证的崩溃被确定为与院前肝素使用显着相关的参数。在单变量分析中，院前接受肝素治疗组的住院死亡率较低(26.8%vs.42.6%,p=0.002)。然而,在回归模型中，院前使用肝素不再是死亡率的重要预测因子(OR=0.992;p=0.981).冠状动脉血运重建前梗死动脉通畅，按TIMI流量等级测量，与OHCA患者的院前肝素给药无关（OR=0.840；p=0.724）。
结论：在患有OHCA的STEMI患者中，院前使用肝素既与梗死动脉的早期通畅性改善无关,也与更好的预后无关.我们的结果不支持在STEMI患者OHCA院前治疗阶段肝素给药具有积极作用的假设。
背景：ClinicalTrials.gov：NCT00794001。
方法：评估院前肝素负荷对STEMI合并OHCA患者TIMI（心肌梗死溶栓）血流分级和死亡率的影响，我们分析了来自两家医院的2,566名连续患者的数据,这些患者参与了前瞻性反馈干预和ST段抬高型心肌梗死(FITT-STEMI)试验.
结果：在394名OHCA参与者中，272人（69％）从紧急医疗服务（EMS）接受了肝素。EMS（比值比（OR）=3.53，95％置信区间（CI）=1.54-8.09；p=0.003）和院前心电图记录（OR=3.32，95％CI=1.06-10.35；p=0.039）见证的崩溃被确定为与院前肝素使用显着相关的参数。在单变量分析中，院前接受肝素治疗组的住院死亡率较低(26.8%vs.42.6%,p=0.002)。然而,在回归模型中，院前使用肝素不再是死亡率的重要预测因子(OR=0.992;p=0.981).冠状动脉血运重建前梗死动脉通畅，按TIMI流量等级测量，与OHCA患者的院前肝素给药无关（OR=0.840；p=0.724）。
结论：在患有OHCA的STEMI患者中，院前使用肝素既与梗死动脉的早期通畅性改善无关,也与更好的预后无关.我们的结果不支持在STEMI患者OHCA院前治疗阶段肝素给药具有积极作用的假设。
背景：ClinicalTrials.gov：NCT00794001。
