Official websites use. Share sensitive information only on official, secure websites. Department of Cardiology, Clinical Sciences, Lund University, 85 Lund, Sweden. Unfractionated heparin UFH is frequently administered before percutaneous coronary intervention PCI in patients with ST-segment elevation myocardial infarction STEMI. The aim of the study was to investigate if pretreatment with UFH prior to arrival at the catheterisation laboratory affects coronary artery occlusion, mortality, and in-hospital major bleeding in patients with STEMI undergoing PCI. Patients with a first STEMI event undergoing PCI between and were extracted from the Swedish Coronary Angiography and Angioplasty Registry. Risk ratios for UFH pretreatment versus no pretreatment regarding coronary artery occlusion at presentation in the catheterisation laboratory, day mortality, and bleeding were obtained using adjusted Poisson regression models with robust standard errors. Analyses of propensity score PS -matched groups were performed to obtain absolute risk differences. Adjusted risk ratios were 0. Pretreatment with UFH was associated with a reduction in coronary artery occlusion among patients with STEMI, with a number needed to treat NNT of 12, without increasing the risk of major in-hospital bleeding. Regarding mortality, a reduction was found with UFH pretreatment, with an NNT of 94, but this effect was not robust over all sensitivity analyses and residual confounding cannot be excluded. Percutaneous coronary intervention PCI is the gold standard for reperfusion therapy in patients with ST-segment elevation myocardial infarction STEMI. Pretreatment with unfractionated heparin UFH prior to arrival at the coronary catheterisation laboratory is often administered with the intention to improve spontaneous reperfusion rates and reduce clot burden 1. Improved coronary blood flow prior to PCI has previously been shown to improve patient outcome 2. After intravenous administration, the maximum effect of UFH is achieved within minutes. Furthermore, the half-life is short, between 1 and 2 hours. These characteristics, combined with the availability of an antidote, potentially makes UFH a good candidate for early administration in STEMI patients. Scientific evidence regarding UFH pretreatment in patients with STEMI undergoing PCI is scarce. Only 1 small randomised controlled trial RCT dating back to the late 90s 3 and 10 observational studies with varying results regarding patient-relevant outcomes exist 14567891011 Furthermore, evidence on absolute risk differences is sparse, restricted to 1 small non-randomised study 4and available evidence regarding mortality is inconclusive. This is reflected in current guidelines where UFH is endorsed for use during PCI, but there are no clear recommendations for UFH pretreatment prior to arrival at the coronary catheterisation laboratory 13 In Sweden, there are 30 centres performing PCI, each with their own local routines and traditions; no consensus has been reached regarding UFH pretreatment. Thus, the aim of the present study was to investigate relative risks and absolute risk differences for the clinical effects of UFH pretreatment, including coronary artery occlusion at presentation in the Dating Portal Blueline Im Vergleich laboratory, mortality at 30 days, and major in-hospital bleeding for patients with STEMI undergoing primary PCI. In this cohort study, data from the Swedish Coronary Angiography and Angioplasty Registry SCAAR and the National Patient Register were used. SCAAR is a Swedish nationwide register where data regarding myocardial infarctions MI from all hospitals with a cardiac intensive care unit as well as data from all Dating Portal Blueline Im Vergleich angiographies and PCI procedures in Sweden are recorded. Patient data are reported by the handling physician via a web interface. Inthe register had a coverage rate of The study Dating Portal Blueline Im Vergleich consisted of unique patients with a first STEMI event undergoing primary PCI during the study period from January to December The date of PCI was defined as the index date. Patients with chronic total occlusions, missing information regarding UFH pretreatment, and with rescue PCI following thrombolysis were excluded. From SCAAR, data regarding age, sex, body mass index BMIsmoking status, year of PCI, previous medical history coronary artery bypass graft [CABG], diabetes, hyperlipidaemia, hypertension, MIantithrombotic treatment before and during PCI, and the time from symptom onset to PCI were extracted. In Sweden, the dose of UFH pretreatment is often 5, U. However, the dose and the exact timing of the treatment is not recorded in the register. To reflect the severity of the STEMI as well as differences in procedure, the location of the infarction proximal versus not proximal and access radial versus non-radial were recorded. From the patient register, we extracted diagnoses before the index date: bleeding, chronic obstructive pulmonary disease COPDheart failure, kidney failure, peripheral vessel disease, and stroke. The outcomes were coronary artery occlusion at presentation in the catheterisation laboratory, day mortality, and major in-hospital bleeding. Coronary artery occlusion was determined by the PCI physician prior to the PCI.
Um die Gesamtbewertung der Sterne und die prozentuale Aufschlüsselung nach Sternen zu berechnen, verwenden wir keinen einfachen Durchschnitt. Weitere Rezensionen ansehen. Kopiere den aktuellen Link. Eine Person fand diese Informationen hilfreich. Kuriositäten: Zwölf skurrile Produkte, die man bei Amazon erwerben kann von Anna Scheibe Artikel merken. In this study, comparing unfractionated heparin pretreatment with no pretreatment in patients with STEMI undergoing primary PCI, we show a significant relative risk reduction in coronary artery occlusion at the time of angiography as well as an absolute risk reduction with an NNT of 12, without an increased risk of major bleeding.
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