背景:缺乏支持疑似非ST段抬高急性冠脉综合征(NSTE-ACS)患者院前肝素给药的证据。我们旨在评估急诊医疗服务院前肝素管理是否可以改善疑似NSTE-ACS患者的临床预后。
方法:从2013年至2021年,前瞻性纳入急诊就诊的疑似心肌梗死(MI)患者,排除ST段抬高型MI患者。使用倾向评分匹配比较有和没有院前肝素给药的患者。为了评估院前肝素负荷之间的关联,30天和1年死亡率,使用Kaplan-Meier估计和Cox回归模型。
结果:在1,234名患者中,中位年龄为69岁,755(61.2%)为男性,867(70.5%)已知高血压,177(14.4%)患有糖尿病,280人(23.1%)是目前的吸烟者,444人(36.0%)有CAD病史。与未接受院前肝素治疗的患者相比,肝素预处理的患者更经常是活跃的吸烟者(26.5%vs.20.8%)。在倾向匹配之后,475例患者与没有院前肝素给药进行比较,30天死亡率无显著差异(无肝素1.3%与肝素0.4%)和1年死亡率(无肝素7.2%与肝素5.5%,调整后的HR0.98,CI0.95-1.01,p=0.22)。出血事件发生频率较低(<2%),组间无差异。
结论:在这项研究中,在疑似NSTE-ACS患者中,院前肝素给药与改善临床结局无关.这些发现对该患者人群的院前肝素治疗提出了质疑,并且可能需要在住院风险评估之前进行更多限制的使用。
BACKGROUND: Evidence supporting pre-hospital
heparin administration in patients with suspected non-ST segment elevation acute coronary syndrome (NSTE-ACS) is lacking. We aim to evaluate if pre-hospital
heparin administration by emergency medical service improves clinical outcome in patients with suspected NSTE-ACS.
METHODS: Patients with suspected myocardial infarction (MI) presenting to the emergency department were prospectively enrolled from 2013 to 2021, excluding those with ST segment elevation MI. Patients with and without prehospital heparin administration were compared using propensity score matching. To assess the association between pre-hospital heparin loading, 30-day and 1-year mortality, Kaplan-Meier estimations and Cox regression models were used.
RESULTS: Among 1,234 patients, median age was 69 years, 755 (61.2%) were male, 867 (70.5%) with known hypertension, 177 (14.4%) had diabetes, 280 (23.1%) were current smokers, and 444 (36.0%) had a history of CAD. Compared to patients without pre-hospital
heparin administration,
heparin pre-treated patients were more often active smokers (26.5% vs. 20.8%). After propensity matching, 475 patients with vs. without pre-hospital heparin administration were compared, with no significant difference in 30-day mortality (no-
heparin 1.3% vs.
heparin 0.4%) and 1-year mortality (no-
heparin 7.2% vs.
heparin 5.5%, adjusted HR 0.98, CI 0.95-1.01, p = 0.22). Bleeding events occurred at a low frequency (< 2%) and did not differ between groups.
CONCLUSIONS: In this study, pre-hospital heparin administration was not associated with improved clinical outcome in patients with suspected NSTE-ACS. These findings question pre-hospital heparin therapy in this patient population and might potentially warrant a more restricted utilization pending in-hospital risk assessment.