Heparin pre-treatment in patients with ST-segment elevation myocardial infarction and the risk of intracoronary thrombus and total vessel occlusion. Insights from the TASTE trial

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@article{4f5cea849fdd412a8d578dfaff886c86,
title = "Heparin pre-treatment in patients with ST-segment elevation myocardial infarction and the risk of intracoronary thrombus and total vessel occlusion. Insights from the TASTE trial",
abstract = "BACKGROUND: Pre-treatment with unfractionated heparin is common in ST-segment elevation myocardial infarction (STEMI) protocols, but the effect on intracoronary thrombus burden is unknown. We studied the effect of heparin pre-treatment on intracoronary thrombus burden and Thrombolysis in Myocardial Infarction (TIMI) flow prior to percutaneous coronary intervention in patients with STEMI.METHODS: The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial angiographically assessed intracoronary thrombus burden and TIMI flow, prior to percutaneous coronary intervention, in patients with STEMI. In this observational sub-study, patients pre-treated with heparin were compared with patients not pre-treated with heparin. Primary end points were a visible intracoronary thrombus and total vessel occlusion prior to percutaneous coronary intervention. Secondary end points were in-hospital bleeding, in-hospital stroke and 30-day all-cause mortality.RESULTS: Heparin pre-treatment was administered in 2898 out of 7144 patients (41.0{\%}). Patients pre-treated with heparin less often presented with an intracoronary thrombus (61.3{\%} vs. 66.0{\%}, p<0.001) and total vessel occlusion (62.9{\%} vs. 71.6{\%}, p<0.001). After adjustments, heparin pre-treatment was independently associated with a reduced risk of intracoronary thrombus (odds ratio (OR) 0.73, 95{\%} confidence interval (CI)=0.65-0.83) and total vessel occlusion (OR 0.64, 95{\%} CI=0.56-0.73), prior to percutaneous coronary intervention. There were no significant differences in secondary end points of in-hospital bleeding (OR 0.84, 95{\%} CI=0.55-1.27), in-hospital stroke (OR 1.17, 95{\%} CI=0.48-2.82) or 30-day all-cause mortality (hazard ratio 0.88, 95{\%} CI=0.60-1.30).CONCLUSIONS: Heparin pre-treatment was independently associated with a lower risk of intracoronary thrombus and total vessel occlusion before percutaneous coronary intervention in patients with STEMI, without evident safety concerns, in this large multi-centre observational study.",
keywords = "Journal Article",
author = "Sofia Karlsson and Pontus Andell and Mohammad, {Moman A} and Sasha Koul and Olivecrona, {G{\"o}ran K} and James, {Stefan K} and Ole Fr{\"o}bert and David Erlinge",
year = "2019",
doi = "10.1177/2048872617727723",
language = "English",
volume = "8",
pages = "15--23",
journal = "European Heart Journal: Acute Cardiovascular Care",
issn = "2048-8734",
publisher = "SAGE Publications Inc.",
number = "1",

}