Heparin administration at first medical contact vs immediately before primary percutaneous coronary intervention: the HELP-PCI trial

作者：Jing Chen, Jing Chen, Changwu Xu, Liqiang Qiu, Bin Li, Wei Yao, Liaoliao Hu, Guang Xu, Guang Xu, Dongmei Zhu, Zhengzai Li, Xiaolin Wu, Chuang Xiao, Bo Liu, Xiuzhen Shen, Zhaowu Deng, Chaogui Zhuo, Huajun Su, Keping Yang, Meichun Zhang, Meichun Zhang, Chang Li, Xuexiang Lv, Li-Feng Hong, Fan Guo, Hao Xu, Hao Xu, Mingjian Li, Liqun He, Wenjun Wu, Dongsheng Li, Dongsheng Li, Huoping Li, Shaoze Chen, Hong Bao, Xuguang Xiong, Bo Liu, Guokang Yang, Jinke Chen, Jinke Chen, Lan Xiao, Mingxi Zhang, Jian Yang, Mingxi Zhang, Jian Yang, Hong Jiang · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf481 · 被引用次数：14 · 研究领域：Acute Myocardial Infarction Research、Mechanical Circulatory Support Devices、Coronary Interventions and Diagnostics

BACKGROUND AND AIMS: The beneficial effect of pre-treatment with unfractionated heparin (UFH) at first medical contact (FMC) before primary percutaneous coronary intervention (PPCI) in all-comers with ST-elevation myocardial infarction (STEMI) remains uncertain. METHODS: HELP-PCI was an investigator-initiated, randomized controlled trial conducted at 36 clinical centres in China. Patients with STEMI presenting ≤12 h after symptom onset undergoing PPCI were randomly assigned (1:1) to intravenous administration with UFH (100 U/kg) at FMC or in the Cath Lab through a catheter sheath. The primary endpoint was Thrombolysis in Myocardial Infarction flow grade (TFG)-3 of infarct-related artery (IRA) at diagnostic angiography before PPCI. The secondary outcome was complete epicardial and myocardial reperfusion after PPCI and major adverse cardiac and cerebrovascular events (MACCE; defined as the composite of all-cause death, cardiac death, heart failure hospitalizations, re-infarction, stent thrombosis, unplanned revascularization, and stroke) at 12 months. Safety outcome was 30-day Bleeding Academic Research Consortium (BARC) type ≥2 bleeding. RESULTS: A total of 999 patients with STEMI undergoing PPCI were randomly assigned to receive either UFH administration at FMC (n = 505) or in the Cath Lab (n = 494). Pre-treated population at FMC showed a higher frequency of TFG-3 of IRA compared with the Cath Lab group (23.6% vs 17.6%; odds ratio, 1.44; 95% confidence interval, 1.06-1.97; P ...